Precertification Specialist JMC

Mercyhealth Wisconsin and Illinois

About The Position

At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin. Mercyhealth has been nationally recognized for our commitment to our people and culture, including: #1 in the nation on AARP’s Best Employers for Workers Over 50 One of Working Mother magazine’s 100 Best Companies for Working Mothers A Top 50 Company and Top 10 Nonprofit for Executive Women For over 135 years, Mercyhealth has provided high-quality health care to residents throughout northern Illinois and southern Wisconsin. We have a passion for providing comprehensive health care close to home for area residents through our six hospitals and 85 primary and specialty care locations. As an integrated health system, you can come to us for routine health care, like annual physicals, immunizations and preventive health screenings, as well as highly specialized care, such as neonatal intensive care, heart surgery, stroke care, neurosurgery, cancer treatment and much more. The range of Mercyhealth's specialties and the skills of our doctors, nurses and clinical staff are truly extraordinary.

Requirements

High school diploma or equivalent required.
One year of healthcare registration, scheduling, or physicians office experience required.
Completion of 24 twenty four hours of coursework in a business or healthcare related field of study may be considered in lieu of healthcare office experience.
Excellent oral communication skillsorganizational skills
Ability to handle stress problem solve
Computer experience required
Able to work independently
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands arms; climb or balance; stoop, kneel, crouch, or crawl; talk or hear.
The employee is frequently required to sit work at a computer for long periods of time.
The employee is occasionally required to stand.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception ability to adjust focus.
While performing the duties of this job, the employee must have good manual dexterity to operate keyboard telephone; repetitive fingerwrist movement associated with use of keyboard; prolonged sitting.
The employee must be able to lift or move office related objects
Some independent judgment is required, but alternatives are limited by standard practices or procedures.

Nice To Haves

Knowledge of Epic desirable

Responsibilities

Identify all scheduled patients requiring pre-certification or pre-determination through various systems.
Review patient schedules and acquire all data elements and information from the various systems to acquire precertification.
Contacts insurance companies or employer groups to obtain precertifications, predeterminations, and determine eligibility and benefits for necessary services.
Make necessary contact to follow up if there are insurance issues in order to obtain financial resolution and payment on account.
Obtain necessary clinical documentation to use in the pre-certification process.
Timely documentation of referrals authorizations pre-certifications in appropriate systems.
Coordinates follow-up to ensure all payor requirements are met and payment is expected.
Communicates with designated Mercy Partners, Patient Financial Counselors regarding outcome of precertifications, benefits and patient financial responsibility.
Obtains insurance information to complete payor requirements.
Maintains current knowledge of payor payment provisions and regulations.
Keeps abreast of denials related to pre-certification & assist with appeal of denials as needed.
Keep current of ICD-9 ICD-10 and CPT coding requirements.
Ability to utilize computer software to complete pre-certification processes.
Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.
Maintains logs and documents activity timely within patient accounting system.
Understands and follows patient confidentiality policies.
Additional duties as assigned or appropriate.