Precertification Specialist JMC

Job Summary

As a Precertification Specialist at Mercy Health System, you will play a crucial role in ensuring financial reimbursement for patient care services. Your responsibilities will include verifying insurance benefits, obtaining clinical information for pre-certification, and communicating effectively with various stakeholders. You will also be responsible for completing necessary forms, processing patient referrals, and utilizing excellent customer service skills. This position requires a moderate understanding of healthcare revenue cycle and the importance of evaluating and securing financial resources to maximize reimbursement.

Key Responsibilities

• Identify scheduled patients requiring pre-certification or pre-determination through various systems
• Review patient schedules and acquire all data elements and information from various systems to acquire precertification
• Contact 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
• Coordinate follow-up to ensure all payor requirements are met and payment is expected
• Communicate with designated Mercy Partners, Patient Financial Counselors regarding outcome of precertifications, benefits, and patient financial responsibility
• Obtain insurance information to complete payor requirements
• Maintain current knowledge of payor payment provisions and regulations
• Keep 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
• Participate in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth
• Maintain logs and documents activity timely within patient accounting system
• Understand and follow patient confidentiality guidelines

Requirements

This position requires a moderate understanding of healthcare revenue cycle and the importance of evaluating and securing financial resources to maximize reimbursement. You will also need to have excellent communication and customer service skills, as well as the ability to work effectively in a team environment.

What We Offer

Mercy Health System is an equal employment opportunity employer functioning under Affirmative Action Plans. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and detail-oriented individual who is passionate about delivering exceptional patient care, we encourage you to apply for this exciting opportunity.