Hybrid Precertification & Authorization Specialist

Mayo Foundation for Medical Education and Research; Rochester (MN); Hybrid; USD 28,929 - 46,838; Full time

Benefits offered by this job

Medical plans

Dental coverage

Vision plan

HSA/FSAs

Retirement plan

Job summary

Mayo Clinic in Rochester, MN is seeking a Precertification and Authorization Representative to support referral, precertification, and prior authorization for commercial, government, and other payors across hospital, ED, and clinic settings. This intermediate role emphasizes accuracy, timeliness, and adherence to QA guidelines within a hybrid work arrangement.

On-site expectations apply within 100 miles of Mayo Clinic campuses.

Qualifications

• High School Diploma or GED and 2+ years of relevant experience required.
• Bachelor’s degree required.
• Knowledge of healthcare terminology and CPT-ICD10 codes; experience in insurance verification and claim adjudication preferred.
• HFMA certification preferred.
• Denial codes knowledge preferred.

Responsibilities

• Resolve referral, precertification, and/or prior authorization to support plan requirements for commercial, government and other payors across hospital, ED and clinic environments.
• May handle pre-appointment insurance review (PAIR) and denials recovery within Patient Access.
• Process pre-certification and prior authorization for WC/TPL, managed care and HMO accounts; work denials for government and non-government accounts.
• Adhere to QA guidelines and productivity standards.

Skills

Reading & communication

Basic computer skills

Mathematical competency

Written & verbal communication

Phone etiquette

Healthcare terminology & CPT-ICD10

Insurance verification & claim adjud

Verbal communication excellence

Ambiguity tolerance & judgement

HFMA certification preferred

Denial codes knowledge preferred

Education

High School Diploma or GED + 2+ years experience

Bachelor’s degree

Tools

Epic RC/EMR

Job description

Mayo Clinic in Rochester, MN is seeking a Precertification and Authorization Representative to support referral, precertification, and prior authorization for commercial, government, and other payors across hospital, ED, and clinic settings. This intermediate role emphasizes accuracy, timeliness, and adherence to QA guidelines within a hybrid work arrangement.

On-site expectations apply within 100 miles of Mayo Clinic campuses.