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Precertification Specialist, Walworth, Day Shift, 80 hrs/2wks

at MercyHealth

Posted: 9/1/2020
Job Status: Full Time
Job Reference #: 12602
Categories: Other/General

Job Description

Walworth, WI

Active Full Time Hourly (80 ppp) FTE 1.0

Work Hours: 8a - 4:30p


Experience a rewarding and fulfilling career with Mercyhealth. Mercyhealth is committed to offering our partners a best place to work. Our unique workplace Culture of Excellence is built upon:

  • Employee engagement, empowerment and growth
  • Teamwork toward our common goal – providing exceptional health care services with a passion for making lives better
  • An atmosphere of caring and quality that cascades throughout the organization

Department/Skill highlights

  • This position is located at Mercy Walworth
  • This position works Monday – Friday 8:00a - 4:30p

Essential duties and Responsibilities

  • Identify all scheduled patients requiring precertification 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 precertification 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 requirements.
  • Ability to utilize computer software to complete precertification processes.
  • Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.
  • Maintains logs and documents activity timely within patient accounting system.
  • Understands and follows patient confidentiality policies.

Education and 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.

Special Physical Demands
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. The employee is occasionally required to stand.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting.  The employee must be able to lift or move office related objects