Precertification and Authorization Rep I - RST



City
Rochester
State
Minnesota
Telecommute
Yes
Department
Finance
Why Mayo Clinic

Diversity and inclusion are integral to Mayo Clinic's mission to provide excellent, culturally relevant care in a welcoming environment to patients from a wide variety of backgrounds and creating an inclusive work environment where differences are valued, allowing individuals to achieve and contribute to their fullest potential. This commitment to diversity is woven into the fabric of Mayo Clinic — we embrace these values as we serve our patients, employees, students, suppliers and communities.

Position description
Actively partner with team members by fostering an inclusive work environment and respecting others with different backgrounds, experiences and perspectives.

The Precertification and Authorization Representative I is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations.
Qualifications
High School Diploma or GED required and 2+ years of relevant experience required
OR
Bachelor’s Degree required

Additional Requirements include:
Ability to read and communicate effectively
Basic computer/keyboarding skills, intermediate mathematic competency
Good written and verbal communication skills
Knowledge of proper phone etiquette and phone handling skills
Additional qualifications
Position requires general knowledge of healthcare terminology and CPT-ICD10 codes. Basic knowledge of and experience in insurance verification and claim adjudication is preferred. Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view. Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. Knowledge of Denial codes is preferred. Knowledge of and experience using an Epic RC/EMR system is preferred.
Exemption status
Non-exempt
Compensation Detail
Education, experience and tenure may be considered along with internal equity when job offers are extended. The minimum pay rate is $21.37 per hour.
Benefits eligible
Yes
Schedule
Full Time
Hours / Pay period
80
Schedule details
Business hours are 7am - 5pm, Monday - Friday. Currently there are 3 rotating shifts: 7:00am-3:30pm / 8:00am - 4:30pm / 8:30am - 5:00pm or later based on workload. Candidates must be flexible and available during these times to cover the business need.
Weekend schedule
Overtime and additional hours on the weekends are possible based on business need.
Site description
Mayo Clinic is located in the heart of downtown Rochester, Minnesota, a vibrant, friendly city that provides a highly livable environment for more than 34,000 Mayo staff and students. The city is consistently ranked among the best places to live in the United States because of its affordable cost of living, healthy lifestyle, excellent school systems and exceptionally high quality of life.
Category
Administration, Business, Finance, Office & Administrative Support
Career profile
Finance
Job posting number
145082BR
Recruiter
Veronica Bartz
Equal opportunity employer
As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the diversity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.