Precertification Specialist

JOB REQUIREMENTS: Overview Verification/certification of patient care

services to ensure financial reimbursement. Responsible for insurance

benefit verification and provision of clinical information for

pre-certification for surgeries and other procedures and services as

required by insurance companies. Interpret medical record documentation

for patient history, diagnosis, and treatment options to facilitate

authorizations. Communicates effectively and professionally with many

stakeholders. Complete necessary forms for insurance companies and

initiates appropriate follow-up. Process patient referrals to other

specialties, both within Mercy Health System and to outside providers,

if necessary. Utilizes excellent customer service by demonstrating

written and oral communication skills. Documents thoroughly and

according to department and health system expectations. This position

requires moderate understanding of healthcare Revenue Cycle and the

importance of evaluating and securing all appropriate financial

resources to maximize reimbursement to the health system. This position

assumes clinical and financial risk of the organization when collecting

and documenting information on behalf of the patient. Performs other

duties as assigned. Responsibilities Essential Duties and

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 and 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 For full info follow application link.

EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity

employer functioning under Affirmative Action Plans.

APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/7C94D31CEFCD4125