JOB REQUIREMENTS: Overview Verification/certification of patient careservices to ensure financial reimbursement. Responsible for insurancebenefit verification & provision of clinical information forpre-certification for surgeries & other procedures & services asrequired by insurance companies. Interpret medical record documentationfor patient history, diagnosis, & treatment options to facilitateauthorizations. Communicates effectively & professionally with manystakeholders. Complete necessary forms for insurance companies &initiates appropriate follow-up. Process patient referrals to otherspecialties, both within Mercy Health System & to outside providers, ifnecessary. Utilizes excellent customer service by demonstrating written& oral communication skills. Documents thoroughly & according todepartment & health system expectations. This position requires moderateunderstanding of healthcare Revenue Cycle & the importance of evaluating& securing all appropriate financial resources to maximize reimbursementto the health system. This position assumes clinical & financial risk ofthe organization when collecting & documenting information on behalf ofthe patient. Performs other duties as assigned. ResponsibilitiesIdentify all scheduled patients requiring pre-certification orpre-determination through various systems. Review patient schedules &acquire all data elements & information from the various systems toacquire precertification. Contacts insurance companies or employergroups to obtain precertifications, predeterminations, & determineeligibility & benefits for necessary services. Make necessary contact tofollow up if there are insurance issues in order to obtain financialresolution & payment on account. Obtain necessary clinical documentationto use in the pre-certification process. Timely documentation ofreferrals/authorizations/pre-certifications in appropriate systems.Coordinates follow-up to ensure all payor requirements are met & paymentis expected. Communicates with designated Mercy Partners, PatientFinancial Counselors regarding outcome of precertifications, benefits &patient financial responsibility. Obtains insurance information tocomplete payor requirements. Maintains current knowledge of payorpayment provisions & regulations. Keeps abreast of denials related topre-certification & assist with appeal of denials as needed. Keepcurrent of ICD-9/ICD-10 & CPT coding requirements. Ability to utilizecomputer software to complete pre-certification processes. Participatesin educational programs to meet mandatory requirements & identifiedneeds with regard to position & personal growth. Maintains logs &documents activity timely within patient accounting system. Understands& follows patient confidentiality policies. Additional duties asassigned... For full info follow application link.EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunityemployer functioning under Affirmative Action Plans. *****APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/19163C55EEE1497D