Precert and Authorization Rep

Mayo Clinic•Rochester, MN

1d•$22 - $34•Hybrid

About The Position

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.

Requirements

High School Diploma or GED required
2+ years of relevant experience required OR Bachelor’s Degree required
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.
General knowledge of healthcare terminology and CPT-ICD10 codes.
Authorization to work and remain in the United States, without necessity for Mayo Clinic sponsorships now, or in the future (for example, be a U.S. Citizen, national, or permanent resident, refugee, or asylee). Mayo Clinic does not participate in the F-1 STEM OPT extension program.

Nice To Haves

Basic knowledge of and experience in insurance verification and claim adjudication is preferred.
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.
Experience in an inbound call center, healthcare support, or related environment
Ability to manage call volume while maintaining accuracy and professionalism
Strong attention to detail with clear, thorough documentation skills
Ability to assess situations quickly and take appropriate action within defined scope
Effective communication skills with ability to explain information clearly
Willingness and ability to learn complex transplant processes and workflows

Responsibilities

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.
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.
Supporting transplant-related insurance and authorization inquiries.
Serving as a primary point of contact for incoming calls and is responsible for addressing questions and resolving issues in real time when possible.
Taking ownership of each call by identifying the concern, completing actions within their scope during the interaction, and documenting clearly for any required follow-up.
Managing inbound calls related to insurance verification, authorization status, and transplant-related inquiries.
Assessing caller needs and addressing concerns during the call to the extent possible.
Locating and sending required documentation (e.g., medical records) as appropriate to resolve the request.
Verifying insurance eligibility and transplant-related benefits when applicable.
Providing accurate, real-time information based on payer requirements and available data.
Documenting all actions clearly and completely to support downstream follow-up.
Identifying and escalating issues that cannot be resolved during the call.
Demonstrating working knowledge of the transplant financial clearance and/or authorization process.