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.
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.
Primary Location: Detroit, Michigan
Facility: DMC Children's Hospital of Michigan
Job Type: Full-time
Shift Type: Days
Shift Begin: 8:30 AMShift End: 5:00 PM
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 2105010916
About DMC Children's Hospital of Michigan
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.