Precertification Specialist

JOB REQUIREMENTS: OVERVIEW: Responsible for identifying patients requiring pre-certification or pre-determination, verifying insurance eligibility and benefits, obtaining necessary clinical documentation, and securing authorizations to ensure procedures are approved before the date of service. Maintains accurate patient account documentation, communicates with insurance companies, provider offices, and financial counselors to resolve coverage issues and support reimbursement while ensuring compliance with payer requirements and patient confidentiality policies. Demonstrates strong organizational, communication, and problem-solving skills while meeting productivity and accuracy standards, providing training and mentoring, and maintaining current knowledge of insurance regulations and coding requirements. SCHEDULE: Remote Full-Time, 40 hours per week. ESSENTIAL DUTIES AND RESPONSIBILITIES Identify all scheduled patients requiring pre-certification or pre-determination through various systems. Identify all relevant patient data elements and information from the various systems to acquire precertification. Contacts insurance companies or employer groups to obtain pre-certifications, predeterminations, and determine eligibility and benefits for necessary services. Make necessary contact to follow up if there are insurance issues in order to obtain financial resolution. Obtain necessary clinical documentation to use in the pre-certification process. Coordinates follow-up timely to ensure procedures are authorized and documented prior to the date of service while ensuring all payor requirements are met to ensure payment. Communicates with designated Mercy Partners, Patient Financial Counselors regarding outcome of pre-certifications, benefits and patient financial responsibility. Obtains insurance information to complete payor requirements. Maintains current knowledge of payor payment provisions and regulations. Keep current of ICD-9/ICD-10 and CPT coding requirements. Ability to utilize computer software to complete pre-certification processes. Meets department productivity and accuracy expectations. Understands and follows patient confidentiality policies. Ability to determine network status, eligibility, and coverage for patients to ensure reimbursement for services. Maintains current knowledge of payor payment provisions and regulations. Communicate in a professional, respectful manner with provider offices regarding peer to peer information for follow-up ensuring authorizations can be obtained for procedures pended for medical review. Follows documentation standards on all patient encounters on appropriate patient account utilizing notes. Ensures account is updated to accurately reflect the current status. Ability to work independently with minimal supervision and be result... For full info follow application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/4B039624BE9047F7