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. 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 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... 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/97C22ACB6B934D80