Pre Authorization Representative

Work Shift

Day

Scheduled Weekly Hours

40

Summary

This position supports Mercy's philosophy of patient centered care by possessing a complete understanding of health insurance industry requirements for preauthorization to ensure medical necessity and appropriateness of delivery of health care resources provided to members as per their benefit package. Responsible for initiating an accurate and complete preauthorization, making required edits on pre-authorizations and initiating follow up as needed.

Job Description

Job Duties

• Performs pre-authorization duties requiring good knowledge of hospital programs and procedures.
• Possesses a complete understanding of health insurance industry requirement for preauthorization per payer.
• Initiates an accurate and complete pre-authorization and makes required edits on pre-authorizations as needed. Includes following up on missing pre-authorization information.
• Understands ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required.
• Interacts frequently with physicians, physician office staff, patients and families.
• Uses the call manager and computer to perform all pre-authorization and scheduling duties.
• Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries.

Knowledge, Skills and Abilities

• Basic proficiency in operation of computer, basic keyboarding, fax machine, filing systems, and telephone systems or call center knowledge.
• Knowledge of medical terminology, anatomy strongly preferred.
• Knowledge of ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required.
• Excellent interpersonal and customer service skills.
• Excellent oral and written communication skills.
• Ability to perform multiple tasks with constant interruptions.

Professional Experience

• Preferred: Experience or training in medical terminology, anatomy, ICD-10 and CPT coding experience.

Education

• High School Diploma or equivalent strongly preferred. Relevant experience to be considered in lieu of degree.
• Preferred: Associates degree, graduate of HIM program, RHIT or RHIA certification.

Licensure, Certification, Registration

• None required.

Pay Rate Type

Hourly

Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years.

Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics.