Authorization Representative I

Exceptional care is a team effort. Even if you've never considered healthcare as a next step, you'll find there are many paths to creating a career at Cleveland Clinic centered on what matters most to you.We are looking to hire an Authorization Representative, who will be interacting with external insurance providers to comply with prior authorization requirements which are set forth by the payers. In this role you will confirm benefits and submit for prior authorization, act as the critical component to process improvement initiatives through Kaizen and lead engagement initiatives within the department. This role is a strong introduction to future growth within the department, including Representative Level I and III, Administrative Program, Quality Assurance and Program Manager positions, and formal leader roles such as Work Leader, Supervisor, Manager and Senior Manager.Our ideal future caregiver will be a quick thinker, have knowledge of healthcare terminology, have experience in authorization related avenues (pre- or post-service), be technologically savvy, thrive in a continuous improvement setting, pay close attention to detail and be able to handle non-standard industry experiences working with the payers and the challenges of facing tight scheduling patterns and growing volumes.Cleveland Clinic provides what matters most: career growth, delivering world-class care to our patients, continuous learning, exceptional benefits and working for an organization that offers many long-term career paths. Join us and experience a culture where opportunities to advance and the support to get there go hand-in-hand.Responsibilities:Cross-trained to staff all areas of Authorization supporting any facility, including but not limited to verification, pre-certification, eligibility, benefits including copays, deductibles and out of pocket expenses.

May be required to flag accounts for high dollar financial clearance. Identifies and utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending, denied or in the appeal process.

Maintains productivity and quality expectations set forth by department.

Performs some registration input in order to ensure accurate patient information for the authorization process.

Identifies and utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending, denied or in the appeal process.

Communicates with physician offices to obtain clinical information and/or coordinate peer-to-per conversations.

Identifies and utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending, denied or in the appeal process.

Other duties as assigned.

Education:High school diploma or equivalent.

Certifications:None required.

Work Experience:Minimum of 2 years of experience in a customer facing role with in person or phone contact.

Candidate must demonstrate PC skills efficiency.

Ability to multitask within multiple accounts in high volume insurance verification processes.

An Associate's degree may substitute for up to one year of the stated experience.

A Bachelor's degree my substitute for up to two years of the stated experience.

Physical Requirements:Ability to communicate and exchange accurate information.

Ability to perform work in a stationary position for extended periods.

Ability to work with physical records or operate a computer or other office equipment.

In some locations, ability to travel throughout the hospital system.

In some locations ability to move up to 25 lbs.

Personal Protective Equipment:Follows Standard Precautions using personal protective equipment.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities