Precertification Specialist

At Mercy Health, we are seeking a highly skilled Precertification Specialist to join our team. As a key member of our Patient Access department, you will play a critical role in ensuring that our patients receive the necessary pre-certifications and authorizations for their services.

• Identify and prioritize patients requiring pre-certification or pre-determination through various systems.
• Review patient schedules and acquire all necessary data elements and information to obtain precertification.
• Communicate with insurance companies and employer groups to obtain precertifications, predeterminations, and determine eligibility and benefits for necessary services.
• Document referrals/authorizations/pre-certifications in appropriate systems and coordinate follow-up to ensure all payor requirements are met and payment is expected.
• Collaborate with Mercy Partners and Patient Financial Counselors to ensure accurate and timely communication of precertification outcomes, benefits, and patient financial responsibility.

• High school diploma or equivalent required.
• One year of healthcare registration, scheduling, or physicians' office experience required.
• Ability to maintain current knowledge of payor payment provisions and regulations.

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 and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee is frequently required to sit and work at a computer for long periods of time.