Precertification Specialist

Mercy-Health-System-Corporation; Janesville (WI); On-site; USD 25,000 - 36,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

FSA/HSA Options

Paid time off

Tuition and certification reimburse—me

Well-being Programs

Employee Discounts

Job summary

Mercyhealth is seeking a Pre-certification Specialist to identify patients needing pre-certification, gather data from multiple systems, and contact insurers for approvals and benefits verification. You will ensure documentation is complete, follow up on any issues, and coordinate with Mercy Partners and Patient Financial Counselors to resolve financial responsibilities.

The role requires strong communication, organizational skills, and ability to work independently, with occasional shifts

Qualifications

• High school diploma or equivalent preferred.
• One year of pre-certifications, medical billing, registration, healthcare experience, or related education preferred.
• Excellent oral communication and organizational skills.
• Computer experience required; Epic experience preferred.

Responsibilities

• Identify all scheduled patients requiring pre-certification or pre-determination.
• Identify all relevant patient data elements from various systems to obtain precertification.
• Contact insurance companies or employer groups for pre-certifications and determine eligibility and benefits.
• Follow up on insurance issues to obtain financial resolution.
• Obtain required clinical documentation for pre-certification.
• Coordinate follow-up to ensure procedures are authorized before the date of service.
• Communicate outcomes to Mercy Partners and Patient Financial Counselors.
• Maintain payor requirements and knowledge of payor payment provisions.
• Provide training and mentoring; may work alternate shifts during peak periods.
• Participate in educational programs and perform other duties as assigned.

Skills

Oral communication

Organizational skills

Stress management

Problem solving

Computer literacy

Education

High school diploma or equivalent

Healthcare-related education/experience

Tools

Epic software

Job description

ESSENTIAL 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 - $26.36Mercyhealth 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