Precertification and Authorization Rep-Remote

Mayo Clinic Health System•Rochester, MN

62d•$21 - $34•Remote

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. 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. Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

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
Position requires general knowledge of healthcare terminology and CPT-ICD10 codes
Requires 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

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
pre-appointment insurance review (PAIR)
denials recovery functions within the Patient Access department
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
adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations