JOB SUMMARY

Responsible for a wide range of duties in support of CAS departmental efficiencies which may include but not limited to verification of benefits, obtaining authorization requirements, and authorization request submissions. Collaborates with CAS department leaders in operational and quality excellence.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

Support clinical pre-authorization services team as follows:

• Verify benefits and determine authorization requirements

• Submits requests for authorizations for simple procedures as determine by leadership

• Triage accounts to identify complex clinical requirement cases and/or escalate any issues to clinician

• Complex cases needing authorization i.e. surgery/wound care/chemo/complex RAD for medical necessity clinical pre-authorization

Customer Service � interaction with clients and Patient access staff. Facilitate cooperate/collaborate on facilitating authorization process to include but not limited to requesting clarification on orders/requesting clinical/follow up on pending requests

Performs the following activities to support the effective operation of the organization�s quality management system. A minimum of 2.5 % of time is spent carrying out the following responsibilities: Participation in quality control audit process; participation in department projects and activities to improve overall Conifer and client scorecard metrics. Provides feedback regarding improvement opportunities for workflow &/or procedures; and the contributes to successful implementation of all the above.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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.