Precertification Specialist 1
$36,546–$54,829 year
On-siteJanesville, Wisconsin, United States
Job Summary
Precertification Specialist 1 responsible for ensuring all scheduled visits are pre-registered and certified/authorized in advance of the service date. Initiates, obtains, and documents referrals/authorizations/pre-certifications in appropriate systems. Registers new and returning patients via Mercy systems/applications for visits within the Mercyhealth System to ensure payment for the service. Performs outbound calls to external providers, patients, and payers, schedules appropriately, and communicates with provider offices as needed. Maintains compliance with Access and Revenue Cycle policies, manages waitlists and scheduling changes, handles patient self-scheduling (MyChart, Telehealth), provides outreach to patients, and delivers a high level of professionalism and patient experience. Requires excellent customer service, ability to articulate information to patients and families, knowledge of payor requirements, HIPAA compliance, and experience with EPIC/EMR systems. Supports training for new partners, participates in scheduling improvements, and ensures proper documentation and coordination across departments to optimize scheduling efficiency and financial clearance.
Required Qualifications
- High school diploma or equivalent required.
- Two years of healthcare registration, scheduling, or physicians' office experience required.
- Two years of customer service experience preferred.
- Certification related to health care revenue cycle (Epic, AAHAM, NAHAM, HMFA, etc.) or an equivalently designated certification approved by management within 1 year of hire.
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