JOB REQUIREMENTS: Overview Verification/certification of patient care
services to ensure financial reimbursement. Responsible for insurance
benefit verification and provision of clinical information for
pre-certification for surgeries and other procedures and services as
required by insurance companies. Interpret medical record documentation
for patient history, diagnosis, and treatment options to facilitate
authorizations. Communicates effectively and professionally with many
stakeholders. Complete necessary forms for insurance companies and
initiates appropriate follow-up. Process patient referrals to other
specialties, both within Mercy Health System and to outside providers,
if necessary. Utilizes excellent customer service by demonstrating
written and oral communication skills. Documents thoroughly and
according to department and health system expectations. This position
requires moderate 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. Performs other
duties as assigned. Responsibilities Essential Duties and
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 requirements.
Ability to utilize computer software to complete pre-certification
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 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/7C94D31CEFCD4125
