Authorization Representative

DMC Children's Hospital of Michigan - Detroit, MI4.2

Under general supervision is responsible for securing and tracking authorizations/referrals through patient's length of stay or visit. Assures authorizations/referrals and re-authorizations are obtained and secured for hospital and clinic patients. Participates in the care and customer service process by ensuring all authorizations have been received. Assures appropriate verified insurance information has been updated in SMS registration pathways to ensure timely payment and to meet clean claim requirements. Coordinates with outside eligibility vendor and Clinical Resource Management as necessary using established criteria. Obtains financial approvals and supporting documentation for internal financial assistance programs, updates the registration pathways with approval or denial information. Interprets Managed Care contracts and other third party payer contacts in order to secure correct authorization and/or referral. Downloads and updates Dedicated. Authorization log on a daily basis. Provides various reports to management. [BRASSRING IMPORT 9/1/16]

1.High School diploma or equivalent. Associate degree in finance or business administration highly desirable. 2.Four or more years of prior work experience in patient registration, patient accounting and knowledge of third party payors. 3.Familiarity with medical terminology and concepts. 4.Working knowledge with third party insurance verification, respective systems, authorization, referral procedures and clinical care process internal and external. 5.Comprehensive knowledge of patient access process. 6. Working knowledge of Michigan based Managed Care programs. [BRASSRING IMPORT 9/1/16]
JOB: Clerical/Administrative
PRIMARY LOCATION: Detroit, Michigan
FACILITY: DMC Children's Hospital Of Michigan
JOB TYPE: Full-Time

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.