Pre-Certification Coordinator (Non-Exempt)

Find your calling at Mercy!

The Precert-Preauth Coordinator is responsible for multiple facets of patient financial account services within the practice; including but not limited to patient benefit assessment, insurance verification, pre-certification, pre-authorizations, pre-determination for services, and referrals management. The position requires a thorough understanding of office-management software and a good working knowledge of medical/surgical clinical procedures, claims procedures and insurance company regulations. Requires accuracy, attention to detail and ability to communicate well with physicians, staff, patients and provider representatives of insurance companies.

Position Details:

Pre-Certification Coordinator

Position Summary

The Pre-Certification Coordinator is responsible for verifying patient insurance coverage, obtaining required referrals, prior authorizations, and pre-certifications for medical services, procedures, and treatments. This role serves as a liaison between patients, providers, insurance carriers, and billing teams to ensure timely authorization, accurate documentation, and clear communication regarding insurance benefits and financial responsibility.

Key Responsibilities

• Verify and document patient insurance coverage and benefits to determine eligibility for physician visits, diagnostic testing, surgical procedures, and other healthcare services.
• Obtain required referrals, pre-certifications, and prior authorizations for hospitalizations, surgeries, diagnostic procedures, treatments, and physician services in accordance with payer requirements.
• Communicate patient insurance benefits, coverage limitations, and estimated out-of-pocket expenses for scheduled procedures and services.
• Accurately document insurance verification, authorization approvals, referrals, and financial arrangements within the electronic medical record and applicable databases.
• Prepare, submit, and monitor pre-determination requests with insurance carriers and follow up on authorization status and responses.
• Collaborate with billing services to address account discrepancies, provide insurance updates, and ensure timely reimbursement and accurate patient billing.
• Support financial assistance initiatives by partnering with management, social workers, and care teams to identify patients who may qualify for assistance programs and facilitate the application process.
• Serve as a resource to physicians, clinical staff, and administrative personnel regarding insurance requirements, authorization processes, and billing-related questions.
• Respond to patient inquiries regarding insurance coverage, billing concerns, and financial responsibilities while coordinating resolution with appropriate departments.
• Maintain compliance with organizational policies, payer guidelines, and regulatory requirements.
• Perform additional duties and special projects as assigned.

Minimum Qualifications

Education

• High school diploma or equivalent required.

Experience

• Minimum of two years of experience in healthcare insurance verification, prior authorization, billing, coding, patient access, or a related healthcare revenue cycle function.

Knowledge, Skills, and Abilities

• Knowledge of healthcare insurance plans, benefits verification, referral management, pre-certification, and prior authorization processes.
• Working knowledge of CPT, ICD-10, and HCPCS coding systems.
• Understanding of medical terminology and healthcare reimbursement practices.
• Proficiency with Microsoft Office applications, including Word and Excel.
• Experience using Epic or similar electronic medical record (EMR) systems.
• Strong verbal and written communication skills.
• Excellent organizational, customer service, and problem-solving abilities.
• Strong attention to detail and ability to manage multiple priorities in a fast-paced environment.

Preferred Qualifications

• Certified Coding Specialist (CCS) or related coding certification preferred.
• Experience within a physician practice, hospital, ambulatory surgery center, or healthcare system preferred.
• Additional experience in revenue cycle, patient financial services, insurance authorization, or healthcare billing functions preferred.

Core Competencies

• Insurance Verification & Benefits Coordination
• Prior Authorization & Pre-Certification Management
• Medical Billing & Coding Knowledge
• Patient Financial Counseling
• Revenue Cycle Support
• Healthcare Reimbursement Processes
• EMR Documentation & Data Accuracy
• Customer Service & Patient Advocacy
• Cross-Functional Collaboration

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.