Pre-Certification Coordinator

**Find your calling at Mercy!** =============================== The Precert-Preauth Coordinator is responsible for multiple facets of patient financial account services within the practice; including but not limited to patient benefit assessment, insurance verification, pre-certification, pre-authorizations, pre-determination for services, and referrals management. The position requires a thorough understanding of office-management software and a good working knowledge of medical/surgical clinical procedures, claims procedures and insurance company regulations. Requires accuracy, attention to detail and ability to communicate well with physicians, staff, patients and provider representatives of insurance companies. **Position Details:** ===================== Pre-Certification Coordinator ============================= Position Summary ---------------- The Pre-Certification Coordinator is responsible for verifying patient insurance coverage, obtaining required referrals, prior authorizations, and pre-certifications for medical services, procedures, and treatments. This role serves as a liaison between patients, providers, insurance carriers, and billing teams to ensure timely authorization, accurate documentation, and clear communication regarding insurance benefits and financial responsibility. Key Responsibilities -------------------- * Verify and document patient insurance coverage and benefits to determine eligibility for physician visits, diagnostic testing, surgical procedures, and other healthcare services. * Obtain required referrals, pre-certifications, and prior authorizations for hospitalizations, surgeries, diagnostic procedures, treatments, and physician services in accordance with payer requirements. * Communicate patient insurance benefits, coverage limitations, and estimated out-of-pocket expenses for scheduled procedures and services. * Accurately document insurance verification, authorization approvals, referrals, and financial arrangements within the electronic medical record and applicable databases. * Prepare, submit, and monitor pre-determination requests with insurance carriers and follow up on authorization status and responses. * Collaborate with billing services to address account discrepancies, provide insurance updates, and ensure timely reimbursement and accurate patient billing. * Support financial assistance initiatives by partnering with management, social workers, and care teams to identify patients who may qualify for assistance programs and facilitate the application process. * Serve as a resource to physicians, clinical staff, and administrative personnel regarding insurance requirements, authorization processes, and billing-related questions. * Respond to patient inquiries regarding insurance coverage, billing concerns, and financial responsibilities while coordinating resolution with appropriate departments. * Maintain compliance with organizational policies, payer guidelines, and regulatory requirements. * Perform additional duties and special projects as assigned. Minimum Qualifications ---------------------- ### Education * High school diploma or equivalent required. ### Experience * Minimum of two years of experience in healthcare insurance verification, prior authorization, billing, coding, patient access, or a related healthcare revenue cycle function. ### Knowledge, Skills, and Abilities * Knowledge of healthcare insurance plans, benefits verification, referral management, pre-certification, and prior authorization processes. * Working knowledge of CPT, ICD-10, and HCPCS coding systems. * Understanding of medical terminology and healthcare reimbursement practices. * Proficiency with Microsoft Office applications, including Word and Excel. * Experience using Epic or similar electronic medical record (EMR) systems. * Strong verbal and written communication skills. * Excellent organizational, customer service, and problem-solving abilities. * Strong attention to detail and ability to manage multiple priorities in a fast-paced environment. Preferred Qualifications ------------------------ * Certified Coding Specialist (CCS) or related coding certification preferred. * Experience within a physician practice, hospital, ambulatory surgery center, or healthcare system preferred. * Additional experience in revenue cycle, patient financial services, insurance authorization, or healthcare billing functions preferred. Core Competencies ----------------- * Insurance Verification & Benefits Coordination * Prior Authorization & Pre-Certification Management * Medical Billing & Coding Knowledge * Patient Financial Counseling * Revenue Cycle Support * Healthcare Reimbursement Processes * EMR Documentation & Data Accuracy * Customer Service & Patient Advocacy * Cross-Functional Collaboration **Why Mercy?** ============== From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.