Pre-Service Coordinator

Mercy Cedar Rapids; Baltimore (MD); On-site; USD 25,000 - 39,000; Full time

Job summary

Mercy Cedar Rapids is seeking a Healthcare Billing Specialist to support patient-centered care by coordinating with insurance payors to verify benefits and obtain pre-authorizations for scheduled services.

You will communicate patient liability after the pre-service process, assist with revenue cycle activities, and collaborate with on-site case management and clinical teams to maximize reimbursement and ensure accurate billing.

Qualifications

• One year of related experience in hospital, clinic, medical office, revenue cycle, or customer service.
• Knowledge of insurance verification, authorizations, and patient billing processes.
• HIPAA compliance and strong data handling capabilities.

Responsibilities

• Prepares and clears new cases for pre-scheduled services with insurance data.
• Interacts with insurers to verify benefits and obtain authorizations.
• Gather information to verify benefits using the Epic system.
• Obtain necessary service authorizations with clinical teams and CDI/PRIOR auth.
• Communicate patient liability after pre-service completion.
• Provide service information and logistics to ensure a positive patient experience.
• Support revenue cycle and help develop processes to maximize reimbursement.
• Develop and maintain monthly reports and statistics.

Skills

Strategic thinking

Professional demeanor

Communication

Interpersonal skills

Entrepreneurial mindset

Education

High School Diploma or equivalent

CRCR certification with HMFA or equivalent

Job description

Work Shift

Day/Evening

Scheduled Weekly Hours

40

Summary

This position supports Mercy’s philosophy of patient centered care by assisting patients by communicating with insurance payors, via various methods (i.e. telephone, fax, internet) to determine eligible benefits (full coverage, medical policy determination) and acquiring pre-certification when deemed necessary by the insurance payor. Will also be responsible for communicating the liability to the patient after ensuring the pre-service process has been completed in advance of the patient’s arrival for scheduled services.

Job Description

Job Duties

• Prepares, validates and completes all step necessary to clear new cases for pre-scheduled services. This includes but is not limited to validating and gathering insurance and demographic information.
• Interacts with insurance companies via website, phone, or fax to verify benefits, obtain authorizations, identify insurance guidelines, and facilitate communication.
• Gathers information to verify benefits and benefits eligibility by utilizing the Epic system.
• Completes and/or obtains all necessary authorizations for the service(s) to be performed. Works with clinical providers, on-site case management team, as well as team members LPN/RN or Nurse Auditor in the Prior Authorization or CDI department.
• Performs Pre-Service collection estimation functions and communicates patient liability with patient.
• Provides point of service information and logistics to ensure an exceptional patient experience.
• Assumes responsibility for revenue cycle management and is key in developing processes with hospital department heads to maximize and enhance revenue/reimbursement for services provided. Provides leadership in billing to improve transactional accuracy.
• Develops and maintains reports and statistical information on a timely monthly basis.
• Other related duties as required.
• Follows Mercy’s safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries.

Knowledge, Skills and Abilities

• Excellent strategic skills and overall business judgement; the ability to visualize and implement strategies required to be successful in accounts receivable management and translate this vision into a meaningful specific plan that includes performance improvement in the billing process, is compliant with HIPAA regulation and maximizes payment accuracy.
• A professional demeanor and communication style that fosters credibility with staff, senior management, physicians, department heads, the community, and customers.
• A style that enhances and promotes the ability to operate in an entrepreneurial, fast-moving environment and the ability to function as part of a high-level management team where requirements are to produce results and be responsive to our customers.
• The ability to create, mold and build a successful accounts receivable management program.
• Promote a high degree of interpersonal astuteness, personal integrity, compassion and the ability to gain the trust of department heads, business services staff, physicians, senior management, and the Senior Vice President of Finance.

Professional Experience

• Required: One-year related experience in hospital, clinic, medical office, business services/revenue cycle, front line registration, financial counseling, banking and/or customer service.

Education

• High School Diploma or equivalent required.

Licensure, Certification, Registration

• Preferred: CRCR certification with HMFA or equivalent.

Physical Requirements

Sedentary: Exert up to 10 lbs. of force occasionally and/or a minute amount frequently

Pay Rate Type

Hourly

Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years.

Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics.