Pre-Certification Coordinator - Sleep Lab - Merc Hospital STL

Patient Services & Front Office (PSR Tasks)

• Patient Intake: Greet patients warmly, execute check-in/check-out procedures, and verify accurate demographic information.
• Appointment Scheduling: Coordinate, schedule, and reschedule patient appointments utilizing EHR scheduling workflows.
• Co-Pay Collection: Collect co-payments, past due balances, and self-pay fees at the time of service, issuing accurate receipts.
• Phone Management: Answer incoming multi-line phone calls, route messages to clinical teams, and address patient inquiries promptly.
• Check-Out Procedures: Process patient check-outs, schedule necessary follow-up visits, and distribute summary documentation.

Pre-Certification & Financial Coordination

• Insurance Verification: Confirm patient eligibility, benefit levels, and policy details prior to scheduled appointments.
• Prior Authorizations: Submit, track, and secure pre-certifications, pre-authorizations, and pre-determinations for medical/surgical procedures.
• Referral Management: Review and coordinate incoming and outgoing clinical referrals according to insurance guidelines.
• Payer Communication: Connect with insurance company representatives to resolve coverage issues, review policies, and track pending approvals.
• Data Entry & Management: Update authorization codes, effective dates, and policy boundaries accurately within office-management software.
• Clinical Review: Screen patient records to ensure documented medical necessity mirrors payer authorization rules.
• Patient Financial Counseling: Communicate out-of-pocket responsibilities, network status, and authorization delays clearly to patients.

Education: High school graduate or equivalent.

Experience: Two-year minimum experience working with healthcare insurance, billing and coding.

Certifications: Computer skills: word processing, spreadsheet (Word, Excel), EPIC. Excellent written and verbal communication skills. Knowledge of current coding for CPT/ICD-10/HCPS. Medical terminology.

Preferred Certifications: Certification as Coding Specialist preferred.

Preferred Other

Why Mercy?

• 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.
• Opportunity to join a caring, collaborative team where your voice matters.
• Support for innovation, technology, and compassion in shaping the future of healthcare.

Join Mercy and be part of our mission to improve the health of all we touch.