Precert and Authorization Rep

Mayo Clinic•Rochester, MN

4h•$22 - $34•Hybrid

About The Position

The Precertification and Authorization Representative is an intermediate level position that is responsible for 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. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include 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. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations. The Transplant Precertification and Authorization Representative is a full-time, inbound call center role responsible for supporting transplant-related insurance and authorization inquiries. This position serves as a primary point of contact for incoming calls and is responsible for addressing questions and resolving issues in real time when possible. Representatives are expected to take ownership of each call by identifying the concern, completing actions within their scope during the interaction, and documenting clearly for any required follow-up.

Requirements

Must be located within 100 miles of a Mayo Clinic campus for occasional on-site expectations based on business needs.
Adherence to quality assurance guidelines
Established productivity standards

Responsibilities

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