About this role
Find your calling at Mercy!
Responsible multiple facets of patient account coordination including insurance/benefit verification, denials management and coverage of services as neede and collections.
Responsible for knowing which assistance programs, such as drug copay cards, that patients may qualify for, assisting patients in enrolling in those programs, monitoring services rendered, and billing the assistance programs for the applicable funds. This position requires a thorough understanding of claims programs for the applicable funds.
The Prior authorization representatives are responsible for understanding insurance rules and requirements for tests and different categories of tests ordered to understand how to submit a prior authorization and clinical documentation required to receive an approval.
This position requires a thorough understanding of procedures of prior authorization requests, coding, billing, rejections and denials. It requires monitoring of insurance company regulations for changes in pre-certification, documentation, or claims submission requirements. It also requires accuracy, attention to detail and the ability to communicate well with physicians, staff, patients, and insurance companies. The Prior authorization representative also serves as a resource for other staff and patients, and always performs duties in a manner consistent with Mercy Service Standards. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.
Position Details:
Location
Mercy Southeast - Cardiovascular Consultants Clinic
371 S Broadview
Cape Girardeau, MO 63701
Hours/Schedule
Full-Time (40-hrs per week), Days
Qualifications:
Education: Some college hours in Business, Finance and/or Accounting related courses preferred. Completed certificate or education of CNA, MA, LPN and/or equivalent experience or relevant education.
Licensure:
Experience: A minimum of 3 years related experience required. A minimum of 1 year experience with certificate and/or 3 years minimum relevant experience with clinical role and/or prior authorizations.
Certification/Registration:
Other skills & knowledge: Typing speed 40wpm or higher.
(skills, knowledge, abilities)
Interpersonal, organizational, and analytical skills required. Must possess ability to work in stressful situations, meet deadlines, and perform daily responsibilities with consistent accuracy. Ability to use logic, good judgment ad be able to rapidly identify and initiate corrective actions when problems arise. Must be able to communicate effectively providing good written and oral direction to co-workers. Must be able to work effectively with VBO management and co-workers in demanding situations.
Why Mercy?
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.