Precertification and Authorization Rep-Hybrid

Mayo Career Site UK; Rochester (MN); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Mayo Clinic is seeking a Precertification and Authorization Representative in a hybrid role. You will resolve referrals, precertifications, and prior authorizations to support insurance plan requirements across hospital, ED, and clinic environments.

This intermediate level position may also perform pre-appointment insurance review and denials recovery within Patient Access, handling WC/TPL and managed care accounts as needed, with adherence to quality guidelines and productivity standards.

Responsibilities

• Resolve referral, precertification, and prior authorization for commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments.
• Assist with pre-appointment insurance review (PAIR) and denials recovery within the Patient Access department.

Job description

HYBRID: This is a hybrid position and must be located within 100 miles of any of the Mayo Clinic campuses for on-site expectations based on business needs.

The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations.