WI3673216

1

High School Diploma/GED

High School Diploma/GED Equivalent

Unspecified

40

JOB REQUIREMENTS: Overview 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. Responsibilities
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\... 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/D58F562966634F09