Clinical Clearance & Pre-Auth Specialist

Mary Rutan Health; Bellefontaine (OH); On-site; USD 38,000 - 52,000; Full time

Job summary

Mary Rutan Health in Bellefontaine, OH is seeking a Full-Time Revenue Cycle/Pre-Certification Specialist responsible for contacting insurance companies, physicians, and patients to secure pre-certification and pre-authorization for scheduled services.

You will liaise with physician offices and third-party payors, ensure adherence to payor medical necessity guidelines and MRH policies, and handle payor notifications for non-scheduled inpatient encounters. Reports to the Pre-Service Supervisor.

Qualifications

• Minimum education: High school diploma or GED.
• 2+ years in healthcare Revenue Cycle, especially precertification/authorization.
• Knowledge of medical terminology and clinical documentation.

Responsibilities

• Contact insurance companies, physicians, and patients to obtain pre-certification/authorization for scheduled services.
• Liaise with physician offices and third party payors to coordinate approvals.
• Ensure compliance with payor medical necessity guidelines and MRH policies.
• Conduct payor notifications for non-scheduled inpatient encounters.

Skills

Revenue Cycle

Pre-certification/authorization

Healthcare terminology

Communication skills

Microsoft Outlook

Microsoft Excel

Education

High school diploma or GED

Tools

Microsoft Outlook

Microsoft Excel

Job description

Mary Rutan Health in Bellefontaine, OH is seeking a Full-Time Revenue Cycle/Pre-Certification Specialist responsible for contacting insurance companies, physicians, and patients to secure pre-certification and pre-authorization for scheduled services.

You will liaise with physician offices and third-party payors, ensure adherence to payor medical necessity guidelines and MRH policies, and handle payor notifications for non-scheduled inpatient encounters. Reports to the Pre-Service Supervisor.