Pre Certification Coordinator

MHM Support Services; United States; Remote; USD 36,000 - 60,000; Full time

Job summary

Mercy is seeking a Patient Benefit Representative to manage all aspects of insurance and benefit analysis before services are provided. The role requires strong knowledge of various payors and the ability to secure authorizations and referrals as needed.

You will review appointments, determine out-of-pocket responsibilities, and mentor fellow staff while contributing to timely reimbursement and smooth patient experiences within Mercy.

Qualifications

• Understanding of insurance terminology and medical insurance plans.
• Experience with financial clearance processes and Mercy payment plan options.
• Ability to review appointments and obtain necessary authorizations.

Responsibilities

• Facilitate insurance and benefit analysis prior to service delivery.
• Review patient appointments and admissions for financial clearance.
• Coordinate with insurance companies to secure authorizations and referrals.
• Assist and mentor fellow Patient Benefit co-workers.

Job description

Find your calling at Mercy! The Patient Benefit Representative is responsible for facilitating all components related to insurance and benefit analysis prior to the delivery of services. This position must have a strong understanding of various insurances and stay abreast of payor requirements. The Patient Benefit Representative is responsible for reviewing patient appointments and/or admissions, obtaining information related to out of pocket financial responsibility, securing necessary authorizations, performing insurance management, securing insurance referral requirements and coordinates as needed with insurance companies to ensure timely reimbursement.Serves as a mentor to fellow Patient Benefit co-workers.

Position Details

Experience and Education Requirements Demonstration of understanding of all that level 1 is responsible for. Experience with insurance terminology, medical terminology, and medical insurance plans. They demonstrate the ability to complete financial clearance (Mercy payment plan, EPPC, bad debt resolution, etc.).

Minimum Skills, Knowledge and Ability Requirements

• Ability to communicate effectively both orally and in writing, excellent telephone etiquette required.
• Ability to establish and maintain effective working relationships with patients, physicians, clinical and non-clinical hospital staff and insurance companies.
• Strong interpersonal skills.
• Strong organizational skills; attention to detail.
• Ability to work under stress, meet deadlines and perform all daily assignments with consistent accuracy.

Physical Requirements

• Position requires the ability to push, pull, and/or lift 50 lbs on a regular basis.
• Position requires prolonged standing and walking during each shift.
• Position requires the ability to grip, reach, bend, kneel, twist, and squat to perform duties.

Why Mercy?

• From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.

Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.

Transforming the Health of Our Communities

Our Mercy health system was founded by the Sisters of Mercy in 1986. But our heritage goes back more than 195 years. It began with an Irish woman named Catherine McAuley, who was determined to help women and children in Dublin experiencing poverty. Though Catherine had a modest upbringing, she received an unexpected inheritance that allowed her to fulfill that dream. In 1827, she opened the first House of Mercy in Dublin, intending to teach skills to women and educate children. Many volunteers came to help. A few years later, Catherine founded the Sisters of Mercy, one of the first religious orders whose Sisters were free to walk among the poor and visit them in their homes. In 1843, the Sisters of Mercy came to the United States. In 1856, they traveled to St. Louis. In the years to come, they would establish hospitals throughout the Midwest. Many of these would join together in 1986 as Mercy.