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JOB REQUIREMENTS: Overview Precertification Specialist, Patient Access, Days, 80 Hrs / 2 wks Location: Mercyhealth Hospital Walworth; Lake Geneva, WI Hybrid schedule opportunities available after probationary period. Responsible for correctly prioritizing and completing all steps of the scheduling, referral management, authorization, verification and registration process prior to patients receiving services. Identifies scheduling needs, reviews schedules, follows scheduling protocols and enters visit information for appropriate scheduling. Identifies, verifies, and captures appropriate patient demographic information and health insurance benefit eligibility information. Performs payer coverage investigation, as necessary, utilizing both internal and external tools and resources, to obtain reimbursement verification. Utilizes knowledge including, but not limited to, managed care, commercial, government, and work comp insurance billing requirements, as well as current coding guidelines and standards, to ensure resolution of pre-service edits, appropriate management of claims, initiation and direction of accounts for pre-authorization as required, prevention of timely filing claim denials, and procurement of appropriate reimbursement. This position requires 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. 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... 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/82CDF9E9F83B47F7