M
Precert and Authorization Rep
Mayo Clinic
8 hours ago
Full-time
On-site
Rochester, Minnesota, United States
Registered Nurse
This is a hybrid position and must be located within 100 miles of a Mayo Clinic
campus for occasional on-site expectations based on business needs.
The Precertification and Authorization Representative 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.
The Transplant Precertification and Authorization Representative is a full-time,
inbound call center role responsible for supporting transplant-related insurance
and authorization inquiries. This position serves as a primary point of contact
for incoming calls and is responsible for addressing questions and resolving
issues in real time when possible.
Representatives are expected to take ownership of each call by identifying the
concern, completing actions within their scope during the interaction, and
documenting clearly for any required follow-up.
Responsibilities include:
* Managing inbound calls related to insurance verification, authorization
status, and transplant-related inquiries
* Assessing caller needs and addressing concerns during the call to the extent
possible
* Locating and sending required documentation (e.g., medical records) as
appropriate to resolve the request
* Verifying insurance eligibility and transplant-related benefits when
applicable
* Providing accurate, real-time information based on payer requirements and
available data
* Documenting all actions clearly and completely to support downstream
follow-up
* Identifying and escalating issues that cannot be resolved during the call
* Demonstrating working knowledge of the transplant financial clearance and/or
authorization process
During the selection process you may participate in an OnDemand (pre-recorded)
interview that you can complete at your convenience. During the OnDemand
interview, a question will appear on your screen, and you will have time to
consider each question before responding. You will have the opportunity to
re-record your answer to each question - Mayo Clinic will only see the final
recording. The complete interview will be reviewed by a Mayo Clinic staff member
and you will be notified of next steps.
Why Mayo Clinic
Mayo Clinic is top-ranked in more specialties than any other care provider
according to U.S. News & World Report. As we work together to put the needs of
the patient first, we are also dedicated to our employees, investing in
competitive compensation and comprehensive benefit plans
[https://jobs.mayoclinic.org/benefits/] – to take care of you and your family,
now and in the future. And with continuing education and advancement
opportunities at every turn, you can build a long, successful career with Mayo
Clinic.
Benefits Highlights
* Medical: Multiple plan options.
* Dental: Delta Dental or reimbursement account for flexible coverage.
* Vision: Affordable plan with national network.
* Pre-Tax Savings: HSA and FSAs for eligible expenses.
* Retirement: Competitive retirement package to secure your future.
Just as our reputation has spread beyond our Minnesota roots, so have our
locations. Today, our employees are located at our three major campuses in
Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at
Mayo Clinic Health System campuses throughout Midwestern communities, and at our
international locations. Each Mayo Clinic location is a special place where our
employees thrive in both their work and personal lives. Learn more about what
each unique Mayo Clinic campus has to offer, and where your best fit is.
[https://jobs.mayoclinic.org/alllocations]
Equal Opportunity
All qualified applicants will receive consideration for employment without
regard to race, color, religion, sex, gender identity, sexual orientation,
national origin, protected veteran status or disability status. Learn more about
the "EOE is the Law" [https://www.eeoc.gov/poster]. Mayo Clinic participates
in E-Verify
[https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf] and
may provide the Social Security Administration and, if necessary, the Department
of Homeland Security with information from each new employee's Form I-9 to
confirm work authorization.
campus for occasional on-site expectations based on business needs.
The Precertification and Authorization Representative 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.
The Transplant Precertification and Authorization Representative is a full-time,
inbound call center role responsible for supporting transplant-related insurance
and authorization inquiries. This position serves as a primary point of contact
for incoming calls and is responsible for addressing questions and resolving
issues in real time when possible.
Representatives are expected to take ownership of each call by identifying the
concern, completing actions within their scope during the interaction, and
documenting clearly for any required follow-up.
Responsibilities include:
* Managing inbound calls related to insurance verification, authorization
status, and transplant-related inquiries
* Assessing caller needs and addressing concerns during the call to the extent
possible
* Locating and sending required documentation (e.g., medical records) as
appropriate to resolve the request
* Verifying insurance eligibility and transplant-related benefits when
applicable
* Providing accurate, real-time information based on payer requirements and
available data
* Documenting all actions clearly and completely to support downstream
follow-up
* Identifying and escalating issues that cannot be resolved during the call
* Demonstrating working knowledge of the transplant financial clearance and/or
authorization process
During the selection process you may participate in an OnDemand (pre-recorded)
interview that you can complete at your convenience. During the OnDemand
interview, a question will appear on your screen, and you will have time to
consider each question before responding. You will have the opportunity to
re-record your answer to each question - Mayo Clinic will only see the final
recording. The complete interview will be reviewed by a Mayo Clinic staff member
and you will be notified of next steps.
Why Mayo Clinic
Mayo Clinic is top-ranked in more specialties than any other care provider
according to U.S. News & World Report. As we work together to put the needs of
the patient first, we are also dedicated to our employees, investing in
competitive compensation and comprehensive benefit plans
[https://jobs.mayoclinic.org/benefits/] – to take care of you and your family,
now and in the future. And with continuing education and advancement
opportunities at every turn, you can build a long, successful career with Mayo
Clinic.
Benefits Highlights
* Medical: Multiple plan options.
* Dental: Delta Dental or reimbursement account for flexible coverage.
* Vision: Affordable plan with national network.
* Pre-Tax Savings: HSA and FSAs for eligible expenses.
* Retirement: Competitive retirement package to secure your future.
Just as our reputation has spread beyond our Minnesota roots, so have our
locations. Today, our employees are located at our three major campuses in
Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at
Mayo Clinic Health System campuses throughout Midwestern communities, and at our
international locations. Each Mayo Clinic location is a special place where our
employees thrive in both their work and personal lives. Learn more about what
each unique Mayo Clinic campus has to offer, and where your best fit is.
[https://jobs.mayoclinic.org/alllocations]
Equal Opportunity
All qualified applicants will receive consideration for employment without
regard to race, color, religion, sex, gender identity, sexual orientation,
national origin, protected veteran status or disability status. Learn more about
the "EOE is the Law" [https://www.eeoc.gov/poster]. Mayo Clinic participates
in E-Verify
[https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf] and
may provide the Social Security Administration and, if necessary, the Department
of Homeland Security with information from each new employee's Form I-9 to
confirm work authorization.