Precertification Specialist JMC

ESSENTIAL DUTIES AND 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 requirements & identified needs with regard to position & personal growth.
• Maintains logs & documents activity timely within patient accounting system.
• Understands & follows patient confidentiality policies.
• Additional duties as assigned or appropriate.

EDUCATION AND/OR EXPERIENCE

High school diploma or equivalent required.
One year of healthcare registration, scheduling, or physicians' office experience required. Completion of 24 (twenty four) hours of coursework in a business or healthcare related field of study may be considered in lieu of healthcare office experience.

CERTIFICATION/LICENSURE

N/A

OTHER SKILLS AND ABILITIES
Excellent oral communication skills/organizational skills
Ability to handle stress & problem solve
Computer experience required
Knowledge of Epic desirable
Able to work independently

LEVEL OF SUPERVISION

Some independent judgment is required, but alternatives are limited by standard practices or procedures.

SUPERVISES

This position has no supervisory responsibility.

At Mercyhealth, we don't simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50

• One of Working Mother magazine's 100 Best Companies for Working Mothers

• A Top 50 Company and Top 10 Nonprofit for Executive Women