Pre Authorization Representative

Mercy Medical Center

This position supports Mercy's philosophy of patient centered care by possessing a complete understanding of health insurance industry requirements for pre-authorization 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 pre-authorization, making required edits on pre-authorizations and initiating follow up as needed.
 
Job Duties
  • Uses the call manager and computer to perform all pre-authorization and scheduling duties.
  • Interacts frequently with physicians, physician office staff, patients and families.
  • Understands ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required.
  • Initiates an accurate and complete pre-authorization and makes required edits on pre-authorizations as needed. Includes following up on missing pre-authorization information.
  • Possesses a complete understanding of health insurance industry requirement for pre-authorization per payer.
  • Performs pre-authorization duties requiring good knowledge of hospital programs and procedures.
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.

Location: Mercy Medical Center - Cedar Rapids · Patient Access
Schedule: Full Time, Day, M-F 9-5:30

Job ID: 80944

Posted 19 days ago

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