Precertification and Authorization Rep-Hybrid

Mayo Foundation for Medical Education and Research; Rochester, Northern (MN, KY); Hybrid; USD 30,000 - 47,000; Full time

Benefits offered by this job

Medical plan options

Dental coverage

Vision plan

HSA and FSAs

Competitive retirement package

Job summary

Mayo Clinic is seeking a Precertification and Authorization Representative in Minnesota. This hybrid role supports referrals, precertification, and prior authorization across hospital and clinic settings, within the Patient Access department.

On-site expectations may arise, and the candidate should reside within 100 miles of a Mayo Clinic campus. The position requires a HS diploma or GED with 2+ years of relevant experience or a Bachelor’s degree.

Qualifications

• High School Diploma or GED required.
• Bachelor’s degree required.
• Knowledge of healthcare terminology and CPT-ICD10 codes preferred.
• Experience in insurance verification and claim adjudication preferred.
• HFMA Certification is a plus.

Responsibilities

• Resolve referral, precertification, and prior authorization across hospital, ED, and clinic environments.
• Support PAIR and denials recovery within Patient Access.
• Process precertification and prior authorization for WC/TPL, managed care, and HMOs.
• Handle assigned registration denials for government and non-government accounts.

Skills

Read and communicate effectively

Basic computer skills

Written communication

Phone etiquette

Healthcare terminology

CPT-ICD10 knowledge

Insurance verification

Claim adjudication

Epic RC/EMR experience

HFMA Certification

Education

High School Diploma or GED

Bachelor’s degree

Tools

Epic RC/EMR

Job description

Why Mayo Clinic

Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.

Benefits Highlights

• Medical:Multiple plan options.
• Dental:Delta Dental or reimbursement account for flexible coverage.
• Vision:Affordable plan with national network.
• Pre-Tax Savings:HSA and FSAs for eligible expenses.
• Retirement: Competitive retirement package to secure your future.

Responsibilities

This is a hybrid position and must be located within 100 miles of a Mayo Clinic campus for occasional 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.

Qualifications

High School Diploma or GED and 2+ years of relevant experience required

OR

Bachelor’s degree required

Additional Requirements include:

• Ability to read and communicate effectively
• Basic computer/keyboarding skills, intermediate mathematic competency
• Good written and verbal communication skills
• Knowledge of proper phone etiquette and phone handling skills
• Position requires general knowledge of healthcare terminology and CPT-ICD10 codes. Basic knowledge of and experience in insurance verification and claim adjudication is preferred. Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view. Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. Knowledge of Denial codes is preferred. Knowledge of and experience using an Epic RC/EMR system is preferred. Healthcare Financial Management Association (HFMA) Certification Preferred.

**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.

During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

Exemption Status

Nonexempt

Compensation Detail

$21.91 - $34.27/ hour

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

80

Schedule Details

Rotating schedule: Week 1 - 7:00am-3:30pm Central Week 2 - 8:00am-4:30pm Central Week 3 - 8:30am-5:00pm Central

International Assignment

No

Site Description

Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives.

Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

Equal Opportunity

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the 'EOE is the Law' Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.