Precertification and Authorization Rep-Supplemental/PRN-Hybrid

Mayo Clinic•Rochester, MN

9d•Hybrid

About The Position

The Precertification and Authorization Call Center Representative is an intermediate-level role responsible for supporting referral, precertification, and prior authorization workflows within a high-volume call center environment. This position serves as a key point of contact for insurance payers, physician offices, and patients, facilitating timely communication and coordination throughout the authorization process. While team members do not directly initiate or submit authorizations, they provide critical operational support by managing inbound calls, addressing inquiries, gathering and communicating necessary information, and coordinating next steps with appropriate departments and clinical practices. Team members support more than 23 Prior Authorization specialty skills, requiring the ability to navigate diverse workflows, systems, and departmental processes while adapting to varying customer and authorization needs. Success in this role requires strong communication and customer service skills, adaptability, attention to detail, sound judgment, and the ability to effectively manage competing priorities in a fast-paced environment. Team members are expected to consistently meet established quality, productivity, and compliance standards while maintaining a positive experience for both internal and external customers. To support efficient and effective operations, team members are expected to maintain an average productivity rate of 6.5 calls per hour while demonstrating professionalism, accuracy, responsiveness, and exceptional customer service. Performance expectations include adherence to quality assurance standards, regulatory and compliance requirements, and departmental procedures. Ultimately, success in this role requires effectively balancing productivity with accuracy, customer satisfaction, timely resolution, and operational excellence while contributing to broader departmental goals and service standards.

Requirements

High School Diploma or GED and 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
Excellent verbal communication skills
Ability to work in a complex environment with varying points of view
Comfortable with ambiguity
Good decision making and judgment capabilities
Attention to detail

Nice To Haves

Basic knowledge of and experience in insurance verification and claim adjudication is preferred.
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.

Responsibilities

Managing inbound calls
Addressing inquiries
Gathering and communicating necessary information
Coordinating next steps with appropriate departments and clinical practices
Navigating diverse workflows, systems, and departmental processes
Adapting to varying customer and authorization needs
Meeting established quality, productivity, and compliance standards
Maintaining a positive experience for both internal and external customers
Maintaining an average productivity rate of 6.5 calls per hour
Demonstrating professionalism, accuracy, responsiveness, and exceptional customer service
Adhering to quality assurance standards, regulatory and compliance requirements, and departmental procedures
Balancing productivity with accuracy, customer satisfaction, timely resolution, and operational excellence
Contributing to broader departmental goals and service standards