Pre Authorization Representative

Mercy Cedar Rapids

79d

About The Position

This position supports Mercy's philosophy of patient centered care by possessing a complete understanding of health insurance industry requirements for preauthorization to ensure medical necessity and appropriateness of delivery of health care resources provided to members as per their benefit package. Responsible for initiating an accurate and complete preauthorization, making required edits on pre-authorizations and initiating follow up as needed.

Requirements

• Basic proficiency in operation of computer, basic keyboarding, fax machine, filing systems, and telephone systems or call center knowledge.
• Knowledge of medical terminology, anatomy strongly preferred.
• Knowledge of ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required.
• Excellent interpersonal and customer service skills.
• Excellent oral and written communication skills.
• Ability to perform multiple tasks with constant interruptions.

Nice To Haves

• Experience or training in medical terminology, anatomy, ICD-10 and CPT coding experience.
• Associates degree, graduate of HIM program, RHIT or RHIA certification.

Responsibilities

• Performs pre-authorization duties requiring good knowledge of hospital programs and procedures.
• Possesses a complete understanding of health insurance industry requirement for preauthorization per payer.
• Initiates an accurate and complete pre-authorization and makes required edits on pre-authorizations as needed.
• Includes following up on missing pre-authorization information.
• Understands ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required.
• Interacts frequently with physicians, physician office staff, patients and families.
• Uses the call manager and computer to perform all pre-authorization and scheduling duties.
• Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries.

Benefits

• Generous benefits package
• Opportunities for professional and personal growth
• Supportive team members

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees