Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Processes referrals and prior authorizations using established insurance company guidelines. Obtains referrals, authorizations, pre-certifications, prescriptions for therapies, and benefit verification as required. Efficiently manages referral work queues. Responds to patient inquires and manages referral and/or prior authorization related issues in a timely manner. Assists with patient education as it relates to specific requirements of insurance plans. Facilitates scheduling of specialty services and schedules appointments, as necessary. Verifies insurance coverage, collecting, and documenting insurance benefits and authorization requirements and procuring necessary authorizations for medications, medical devices, outpatient services and referrals according to patient insurance protocols. Acts as a subject matter expert in insurance benefits and authorization requirements.

• Knowledge in governmental and commercial payors, medical billing requirements, and prior authorizations.
• Demonstrated knowledge of Prior Authorization operations and medical office and/or hospital procedures.
• Ability to interpret and cascade payor requirements as they relate to insurance prior authorizations.
• Ability to effectively work in both a team environment and independently.
• Ability to establish and maintain effective working relationships with providers, patients, families, and employees.
• Ability to effectively work in a remote environment and connect via multiple communication channels (phone, email, text, etc.).
• Knowledge of how prior authorization functions impact billing, clinical teams, the quality of care and the patient experience.
• Ability to meet and exceed departmental quality, production, and prior authorization standards.
• Ability to review and resolve denials pertaining to Prior Authorizations.
• Ability to suggest workflows that improve efficiency and experience.
• Ability to mentor and motivate a remote team that delivers exceptional customer service via multiple communication channels (phone, email, text, etc.).
• Skill in Microsoft Office.
• Skill in written and oral communication.
• Complete all aspects of the pre-authorization process within required timeframes. Extract pertinent clinical information from the electronic health record, identify ICD-10 and CPT codes for planned outpatient services and provide to payers utilizing payer specific communication protocols; procure all necessary authorizations prior to service.
• Coordinate peer to peer reviews between the servicing provider and medical directors at the insurance company when appropriate.
• Clearly and thoroughly document all actions, contacts, outcomes, and interventions.
• Obtain retro authorizations on billed and rejected claims and denied procedure codes for facility and professional services. Initiate appropriate follow-up actions in response to information obtained and document outcomes for appeals as needed.
• Other duties as assigned.

• Graduation from high school or an equivalent combination of education and experience.

• Minimum 3 years of experience

   

• 3 or more years of customer service experience within a medical environment
• An associate degree with two years of progressively complex healthcare experience.
• Registration, medical, or surgical specialty clinic and/or insurance experience is preferred.
• Understanding and ability to interpret and communicate insurance benefit information.
• Knowledge and basic understanding of No-Fault Auto, Michigan Assigned Claims, Veteran's Affairs, governmental and third-party payer rules and regulations is preferred.
• Knowledge of pharmacy formularies and Tier coverage.
• Associate degree or combination of High school diploma and 3 years relevant experience is necessary.
• Knowledge of basic medical terminology.
• Must have knowledge of front-end systems (Mi Chart, Cadence, Resolute, Web Denis, M-Connect, I/Observer, etc.) and front-end processes (Check-in, Check-out) including ICD-10 and CPT coding.
• Familiarity with obtaining medical records or professional medical billing financial counseling experience for healthcare patients.
• Individual must exhibit a professional and positive image when interacting with patients, faculty, and staff.
• Must also adhere to high standards of personal and professional conduct, possess excellent customer service, interpersonal, and communication skills, and be able to relate well with people.
• Prior experience performing complex scheduling.
• Financial counseling experience for healthcare patients.
• Exceptional interpersonal skills and ability to work well within a team setting.
• Communicates effectively.
• Demonstrates active listening, written, verbal and information technology skills.

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.

This position will be hybrid, days.

This position is covered under the collective bargaining agreement between the U-M and the Service Employees International Union (SEIU), which contains and settles all matters with respect to wages, benefits, hours, and other terms and conditions of employment.

The University of Michigan conducts background checks on all job candidates upon acceptance of a contingent offer and may use a third party administrator to conduct background checks.  Background checks are performed in compliance with the Fair Credit Reporting Act.

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled any time after the minimum posting period has ended.

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.