Preauthorization Specialist - Healthcare Billing & Appeals

Mercy Medical Center; Cedar Rapids (IA); On-site; USD 28,000 - 36,000; Full time

Job summary

Mercy Medical Center in Cedar Rapids, IA, seeks an experienced Preauthorization Specialist to ensure medical necessity and efficient use of health care resources. You will initiate preauthorizations, review requests, verify benefits, and prepare insurer documentation; collaborate with clinicians and billing to resolve denials and appeals; monitor EDI transactions and maintain thorough records.

Ideal candidates have strong terminology and coding knowledge (CPT/ICD-10), excellent communication,

Qualifications

• Proficiency in Medical Terminology and coding (CPT and ICD-10) is essential.
• Previous experience in medical billing, healthcare administration, or a related field is typically required.
• Excellent interpersonal and written communication skills; ability to multitask.

Responsibilities

• Performs pre-authorization duties obtaining authorizations for tests, procedures and medications.
• Review requests for medical necessity and payer criteria to determine approval.
• Verify patient insurance benefits and eligibility for covered services.
• Prepare and submit documentation to insurance companies with supporting information.
• Maintain records of approvals, denials, and follow-up actions.
• Investigate and resolve denied authorizations, including resubmissions and appeals.
• Monitor AI 278 EDI transactions to ensure attachments and approvals before services.
• Collaborate with providers and clinical teams for additional documentation as needed.
• Initiate waivers when services are denied and communicate status of appeals.

Skills

Medical terminology

ICD-10 CPT coding

Communication skills

multitasking

Call center knowledge

Proficiency with computers

Documentation management

PHI handling

Education

High School Diploma or equivalent

Associates HIM RHIT RHIA preferred

Tools

Call manager

EMR systems

Job description

Mercy Medical Center in Cedar Rapids, IA, seeks an experienced Preauthorization Specialist to ensure medical necessity and efficient use of health care resources. You will initiate preauthorizations, review requests, verify benefits, and prepare insurer documentation; collaborate with clinicians and billing to resolve denials and appeals; monitor EDI transactions and maintain thorough records.

Ideal candidates have strong terminology and coding knowledge (CPT/ICD-10), excellent communication,