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.

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.

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.

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.