Precertification Specialist

Mercy-Health-System-Corporation; Harvard (IL); On-site; USD 38,000 - 60,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Paid time off

Parental leave

Education reimbursement

Job summary

Mercyhealth in Illinois is seeking a Pre-Certifications Coordinator to coordinate insurance pre-certifications and predeterminations, verify eligibility and benefits, collect necessary documentation, and support timely authorization and reimbursement. The role requires strong communication, organization, and computer skills; Epic experience is preferred.

A high school diploma is required and one year of healthcare or billing experience is preferred.

Qualifications

• Excellent oral communication and organizational skills.
• Ability to handle stress and problem solve.
• Computer experience required; familiarity with Epic preferred.
• Ability to work independently with minimal supervision; provide training and mentoring.

Responsibilities

• Identify all scheduled patients requiring pre-certification or pre-determination through various systems.
• Contact insurance companies or employer groups to obtain pre-certifications, predeterminations, and determine eligibility and benefits.
• Obtain necessary clinical documentation to use in the pre-certification process.
• Coordinate timely follow-up to ensure procedures are authorized and documented prior to the date of service.
• Meet department productivity and accuracy expectations; follow documentation standards on all patient encounters.

Skills

Oral communication

Organizational skills

Computer experience

Independent work

Training and mentoring

Epic knowledge

Education

High school diploma or equivalent

Tools

Epic

Job description

OVERVIEW:Coordinates insurance pre-certifications and pre-determinations by verifying eligibility, benefits, network status, and coverage while obtaining required clinical documentation and authorizations. Communicates with insurance companies, providers, and financial teams to resolve coverage issues, ensure accurate documentation, and support timely reimbursement. Maintains knowledge of payer requirements and coding standards while meeting productivity, accuracy, confidentiality, and training expectations.SCHEDULE: Full-time, 40-hours per weekESSENTIAL DUTIES AND RESPONSIBILITIESIdentify all scheduled patients requiring pre-certification or pre-determination through various systems.Identify all relevant patient data elements and information from the various systems to acquire precertification.Contacts insurance companies or employer groups to obtain pre-certifications, predeterminations, and determine eligibility and benefits for necessary services.Make necessary contact to follow up if there are insurance issues in order to obtain financial resolution.Obtain necessary clinical documentation to use in the pre-certification process. Coordinates follow-up timely to ensure procedures are authorized and documented prior to the date of service while ensuring all payor requirements are met to ensure payment.Communicates with designated Mercy Partners, Patient Financial Counselors regarding outcome of pre-certifications, benefits and patient financial responsibility.Obtains insurance information to complete payor requirements.Maintains current knowledge of payor payment provisions and regulations.Keep current of ICD-9/ICD-10 and CPT coding requirements.Ability to utilize computer software to complete pre-certification processes.Meets department productivity and accuracy expectations.Understands and follows patient confidentiality policies.Ability to determine network status, eligibility, and coverage for patients to ensure reimbursement for services. Maintains current knowledge of payor payment provisions and regulations.Communicate in a professional, respectful manner with provider offices regarding peer to peer information for follow-up ensuring authorizations can be obtained for procedures pended for medical review.Follows documentation standards on all patient encounters on appropriate patient account utilizing notes. Ensures account is updated to accurately reflect the current status.Ability to work independently with minimal supervision and be result oriented.Provide training and mentoringMay be required to work alternate shifts, weekends and overtime during peak periods.Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.Performs other duties as assigned.EDUCATION AND/OR EXPERIENCEHigh school diploma or equivalent preferred.One year of pre-certifications, medical billing, registration, healthcare experience, or other business or healthcare related education preferred.CERTIFICATION/LICENSUREN/AOTHER SKILLS AND ABILITIESExcellent oral communication skills/organizational skillsAbility to handle stress and problem solveComputer experience requiredKnowledge of Epic preferredAble to work independentlyLEVEL OF SUPERVISIONSome independent judgment is required, but alternatives are limited by standard practices or procedures.SUPERVISESThis position has no supervisory responsibilityPAY RANGE:$17.57 - $27.97Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.Mercyhealth offers competitive pay and a comprehensive benefits package including:Medical, Dental, VisionLife & Disability InsuranceFSA/HSA OptionsGenerous, accruing paid time offPaid Parental and caregiver leaveCareer advancement and educational opportunitiesTuition and certification reimbursementCertification ReimbursementWell-being ProgramsEmployee DiscountsOn-Demand PayFinancial EducationAnnual recognition/awards eventsPartner appreciation daysFamily entertainment/attractions discountCommunity service/improvement opportunitiesClick here for more details regarding Mercyhealth Careers Benefit Information.At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.Mercyhealth has been nationally recognized for our commitment to our people and culture, including:#1 in the nation on AARP's Best Employers for Workers Over 50One of Working Mother magazine's 100 Best Companies for Working MothersA Top 50 Company and Top 10 Nonprofit for Executive Women