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MercyHealth Javon Bea Hospital RocktonPrecertification Specialist 1
MercyHealth Javon Bea Hospital Rockton is hiring a full-time Precertification Specialist 1 to work remotely for 40 hours per week. This position involves identifying patients who…
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About This Role
MercyHealth Javon Bea Hospital Rockton is hiring a full-time Precertification Specialist 1 to work remotely for 40 hours per week. This position involves identifying patients who need pre-certifications or pre-determinations, verifying insurance eligibility, gathering necessary clinical records, and securing authorizations prior to scheduled procedures. The role requires communicating with insurance providers, physician offices, and financial counselors to address coverage concerns, ensure proper reimbursement, and maintain strict patient confidentiality. The ideal…
Job Description
MercyHealth Javon Bea Hospital Rockton is hiring a full-time Precertification Specialist 1 to work remotely for 40 hours per week. This position involves identifying patients who need pre-certifications or pre-determinations, verifying insurance eligibility, gathering necessary clinical records, and securing authorizations prior to scheduled procedures. The role requires communicating with insurance providers, physician offices, and financial counselors to address coverage concerns, ensure proper reimbursement, and maintain strict patient confidentiality.
The ideal candidate is comfortable working independently with minimal supervision, possesses strong problem-solving and organizational abilities, and can handle work-related stress effectively. Responsibilities also include mentoring and training colleagues, maintaining familiarity with insurance regulations and ICD-9, ICD-10, and CPT coding standards, and meeting established accuracy and productivity targets. During peak periods, staff may need to work overtime, weekends, or alternative shifts.
Mercyhealth operates as an integrated health system with seven hospitals, 85 specialty and primary clinics, and a workforce exceeding 7,500 professionals across southern Wisconsin and northern Illinois. Employee-partners gain access to comprehensive benefits, educational assistance, well-being programs, and professional growth opportunities.
Responsibilities
- Identify scheduled patients needing pre-certifications or pre-determinations across various systems
- Contact insurance companies and employer groups to verify benefits, eligibility, and secure authorizations
- Gather required clinical records to support the precertification procedure
- Communicate outcomes of pre-certifications and patient financial responsibilities to internal partners and financial counselors
- Resolve insurance issues promptly to achieve financial clearance before the date of service
- Maintain updated patient account documentation and notes reflecting current status
- Discuss peer-to-peer clinical information professionally with provider offices for cases pended for medical review
- Provide training and mentoring to team members
- Participate in mandatory educational programs for personal growth and job requirements
Requirements
- Ability to utilize computer software and navigate various systems
- Familiarity with insurance rules, payment provisions, and ICD-9, ICD-10, and CPT coding standards
- Capacity to work independently with minimal supervision in a results-oriented manner
- Availability to work alternate shifts, weekends, and overtime during high-volume periods
Qualifications
- High school diploma or equivalent
- One year of healthcare experience, medical billing, pre-certifications, patient registration, or a related business or healthcare education
- Proficiency in Epic software
Core Skills
Benefits
- Medical, dental, and vision insurance
- Life and disability insurance
- Flexible spending account and health savings account options
- Accruing paid time off
- Paid parental and caregiver leave
- Tuition and certification reimbursement
- Career advancement and educational programs
- Well-being initiatives and employee discounts
- On-demand pay and financial education
- Annual awards events and community service opportunities
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is the Precertification Specialist 1 position remote?
Yes, this is a remote full-time position requiring 40 hours per week.
What is the salary range for this role?
The pay range for this position is $17.57 to $27.97 per hour.
What experience or education is preferred for applicants?
A high school diploma or equivalent is preferred, along with one year of experience in medical billing, pre-certifications, registration, healthcare, or a related business or healthcare education.
Are there any specific schedule requirements?
While it is a standard full-time schedule, employees may occasionally be required to work overtime, weekends, and alternate shifts during peak volume periods.
Sample Interview Questions
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