Precertification and Authorization Rep- Remote

$43,597 - $68,182/Yr

Mayo Clinic - Rochester, MN

Full-time - Entry Level

Remote - Rochester, MN

Hospitals

About the position

The Precertification and Authorization Representative is an intermediate level role focused on resolving referral, precertification, and prior authorization requests to meet insurance plan requirements across various healthcare settings. This position supports both inpatient and outpatient environments and involves pre-appointment insurance reviews and denial recovery functions. The role requires adherence to quality assurance guidelines and productivity standards to ensure effective performance within the Patient Access department.

Responsibilities

• Resolve referral, precertification, and prior authorization requests for various payors.
• Support insurance-specific plan requirements across hospital and clinic environments.
• Process pre-certification and prior authorization for workers compensation and managed care accounts.
• Handle assigned registration denials for government and non-government accounts.
• Conduct pre-appointment insurance reviews and denial recovery functions.
• Adhere to quality assurance guidelines and productivity standards.

Requirements

• High School Diploma or GED with 2+ years of relevant experience, or a Bachelor's degree.
• Ability to read and communicate effectively.
• Basic computer/keyboarding skills and intermediate mathematical competency.
• Good written and verbal communication skills.
• Knowledge of proper phone etiquette and handling skills.
• General knowledge of healthcare terminology and CPT-ICD10 codes.
• Basic knowledge of insurance verification and claim adjudication.

Nice-to-haves

• Knowledge of denial codes.
• Experience using an Epic RC/EMR system.

Benefits

• Competitive compensation
• Comprehensive benefit plans
• Continuing education and advancement opportunities