Responsibilities
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.
Qualifications
Minimum Education: High School Diploma or GED required
Minimum Experience: 2+ years of relevant experience required OR Bachelor’s Degree required
Additional Requirements include:
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. Basic knowledge of and experience in insurance verification and claim adjudication is preferred. 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. Knowledge of Denial codes is preferred. Knowledge of and experience using an Epic RC/EMR system is preferred.N/A
Exemption Status
Nonexempt
Compensation Detail
$23.68 – $31.98 / hour.
Benefits Eligible
Yes
Schedule
Full Time
Hours/Pay Period
80
Schedule Details
100% Remote, can be seated at any site. Monday – Friday – 8:00 am – 5:00 pm.
Weekend Schedule
N/A
International Assignment
No
Site Description
Recruiter
Ronnie Bartz
Department Title
Mayo Clinic Finance
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