USACares Jobs

Job Information

MERCY HEALTH CORPORATION Precertification Specialist in JANESVILLE, Wisconsin

JOB REQUIREMENTS: JOB DESCRIPTION POSITION TITLE: Pre-Certification Specialist JOB CODE: 540 DEPARTMENT: Patient Access/Revenue Cycle Mercyhealth East FLSA STATUS: Non-Exempt SUPERVISED BY: Patient Access Supervisor JOB SUMMARY Verification/certification of patient care services to ensure financial reimbursement. Responsible for insurance benefit verification & provision of clinical information for pre-certification for surgeries & other procedures & services as required by insurance companies. Interpret medical record documentation for patient history, diagnosis, & treatment options to facilitate authorizations. Communicates effectively & professionally with many stakeholders. Complete necessary forms for insurance companies & initiates appropriate follow-up. Process patient referrals to other specialties, both within Mercy Health System & to outside providers, if necessary. Utilizes excellent customer service by demonstrating written & oral communication skills. Documents thoroughly & according to department & health system expectations. This position requires moderate understanding of healthcare Revenue Cycle & the importance of evaluating & securing all appropriate financial resources to maximize reimbursement to the health system. This position assumes clinical & financial risk of the organization when collecting & documenting information on behalf of the patient. Performs other duties as assigned. ESSENTIAL DUTIES & RESPONSIBILITIES Identify all scheduled patients requiring pre-certification or pre-determination through various systems. Review patient schedules & acquire all data elements & information from the various systems to acquire precertification. Contacts insurance companies or employer groups to obtain precertifications, predeterminations, & determine eligibility & benefits for necessary services. Make necessary contact to follow up if there are insurance issues in order to obtain financial resolution & 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 & payment is expected. Communicates with designated Mercy Partners, Patient Financial Counselors regarding outcome of precertifications, benefits & patient financial responsibility. Obtains insurance information to complete payor requirements. Maintains current knowledge of payor payment provisions & regulations. Keeps abreast of denials related to pre-certification & assist with appeal of denials as needed. Keep current of ICD-9/ICD-10 & CPT coding requirements. Ability to utilize computer software to complete pre-certification processes. Participates in educational programs to meet mandatory... 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: