Precertification and Authorization Rep-Remote

Mayo Clinic • Rochester, MN

1d • Remote

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.

Requirements

• High School Diploma or GED and 2+ years of relevant experience OR Bachelor’s degree
• 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

• 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.
• Working assigned registration denials for government and non-government accounts.
• Adherence to quality assurance guidelines.
• Meeting established productivity standards to support the work unit’s performance expectations.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED