Salary Range: $16.95 - 24.69

Starting salary is determined based upon factors that may include years of relevant experience, education, applicable certifications/licensure, and internal equity.

Basic Job Function and Responsibilities

Assures the current status of insurance coverage for potentially enrolled or re-enrolled patients serviced by Mercy Iowa City by confirming, documenting, and accurately communicating primary and secondary payer information required for all insurance billings. This position obtains insurance information and confirms benefit eligibility and prior authorization with the insurance carrier(s). Completes required forms, updates patient information on computer systems.

• Timely and complete processing of eligibility and benefit verification, initial and ongoing authorization requests and accurate entry of related information in designated software system (EHR). Secure prior authorization for, but not limited to, procedures; surgical interventions; imaging; pharmacy and testing.
• Follows policies and procedures to ensure timely communication of verification and authorization status surgery and utilization review, provides necessary information to facilitate decision making for patient admission and visit utilization coverage. Will coordinate with the provider and office of all appeals of prior authorization. Track the status of appeals and communicate appropriately.
• Communicates with management on areas of risk. Provide tracking and regular updates on outstanding issues.
• Maintains efficient tracking of all pending authorizations to ensure timely resolution and avoid loss of revenue. Performs routine reviews of outstanding requests and redirects workloads as appropriate.
• Provides a positive customer service experience to patients and their families by being a liaison to the offices and insurers to resolve and expedite prior authorization; explaining prior authorizations information to patient, offices and hospitals; listening to their concerns, and following through as well as providing feedback on all prior authorization and referral transactions.
• Secures complete and accurate patient demographics, case and financial information to establish the need for a prior authorization.
• Determines third party payers and verifies coverage and prior authorization requirements through eligibility systems, web access and phone calls. Updates all information in the appropriate EHR.
• Routes financial planning issues and concerns from patient, prior to and after services have been provided. Supports clinic management; clinician; and patient financial services.
• Assists in training of new staff.
• Supports and complies with Mercy Corporate compliance standards related to state and federal regulations.
• Performs other related duties as assigned.