Precertification & Authorization Specialist

Mercyhealth Wisconsin and Illinois; Harvard (IL); On-site; USD 25,000 - 39,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

FSA/HSA Options

Paid time off

Parental and caregiver leave

Tuition and certification reimburse

Employee discounts

Job summary

Mercyhealth is seeking an insurance pre-certifications specialist to coordinate pre-certification and pre-determination activities. The role involves verifying eligibility, benefits, network status, and gathering required clinical documents to secure authorizations.

You will contact payors, providers, and financial teams to resolve coverage issues, ensure proper documentation, and support timely reimbursement in a fast-paced environment.

Qualifications

• Excellent oral communication and organizational skills.
• Ability to handle stress and problem solve.
• Computer experience required; knowledge of Epic preferred.
• Able to work independently with minimal supervision.

Responsibilities

• Identify all scheduled patients requiring pre-certification or pre-determination.
• Acquire necessary clinical documentation for pre-certification.
• Contact insurance companies to obtain pre-certifications and determinations.
• Ensure payor requirements are met for procedures and reimbursement.
• Maintain confidentiality and adhere to coding and payor regulations.

Skills

Oral communication

Stress management

Computer skills

Epic knowledge

Independent worker

Education

High school diploma or equivalent

Tools

Epic

Job description

Mercyhealth is seeking an insurance pre-certifications specialist to coordinate pre-certification and pre-determination activities. The role involves verifying eligibility, benefits, network status, and gathering required clinical documents to secure authorizations.

You will contact payors, providers, and financial teams to resolve coverage issues, ensure proper documentation, and support timely reimbursement in a fast-paced environment.