Pre Certification Coordinator

About the Role

The Patient Benefit Representative facilitates all components related to insurance and benefit analysis prior to the delivery of services. This position requires a strong understanding of various insurances and staying current with payor requirements. Responsibilities include reviewing patient appointments and admissions, obtaining out-of-pocket financial responsibility information, securing necessary authorizations, managing insurance referrals, and coordinating with insurance companies to ensure timely reimbursement. Additionally, this role serves as a mentor to fellow Patient Benefit co-workers.

Responsibilities

• Review patient appointments and/or admissions.
• Obtain information related to out-of-pocket financial responsibility.
• Secure necessary authorizations and insurance referral requirements.
• Coordinate with insurance companies to ensure timely reimbursement.
• Perform insurance management tasks.
• Complete financial clearance (e.g., Mercy payment plan, EPPC, bad debt resolution).
• Mentor fellow Patient Benefit co-workers.

Requirements

• Demonstrated understanding of all responsibilities at Level 1.
• Experience with insurance terminology, medical terminology, and medical insurance plans.
• Ability to complete financial clearance tasks (e.g., Mercy payment plan, EPPC, bad debt resolution).

Qualifications

• Effective oral and written communication skills, including excellent telephone etiquette.
• Ability to establish and maintain effective working relationships with patients, physicians, clinical and non-clinical hospital staff, and insurance companies.
• Strong interpersonal and organizational skills with keen attention to detail.
• Ability to work under stress, meet deadlines, and perform daily assignments with consistent accuracy.

Physical Requirements

• Ability to push, pull, and/or lift 50 lbs on a regular basis.
• Prolonged standing and walking during each shift.
• Ability to grip, reach, bend, kneel, twist, and squat to perform duties.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Tuition support.
• Matched retirement plans for team members working 32+ hours per pay period.