Pre Authorization Representative

Work Shift Day Scheduled Weekly Hours 40 Summary This position supports Mercy's philosophy of patient centered care by possessing a complete understanding of health insurance industry requirements for preauthorization to ensure medical necessity and appropriateness of delivery of health care resources provided to members as per their benefit package. Responsible for initiating an accurate and complete preauthorization, making required edits on pre-authorizations and initiating follow up as needed.

Job Description

Job Duties Performs pre-authorization duties requiring good knowledge of hospital programs and procedures. Possesses a complete understanding of health insurance industry requirement for preauthorization per payer. Initiates an accurate and complete pre-authorization and makes required edits on pre-authorizations as needed. Includes following up on missing pre-authorization information. Understands ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required. Interacts frequently with physicians, physician office staff, patients and families. Uses the call manager and computer to perform all pre-authorization and scheduling duties. Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries. Knowledge, Skills and Abilities Basic proficiency in operation of computer, basic keyboarding, fax machine, filing systems, and telephone systems or call center knowledge. Knowledge of medical terminology, anatomy strongly preferred. Knowledge of ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required. Excellent interpersonal and customer service skills. Excellent oral and written communication skills. Ability to perform multiple tasks with constant interruptions. Professional Experience Preferred: Experience or training in medical terminology, anatomy, ICD-10 and CPT coding experience. Education High School Diploma or equivalent strongly preferred. Relevant experience to be considered in lieu of degree. Preferred: Associates degree, graduate of HIM program, RHIT or RHIA certification. Licensure, Certification, Registration None required. Pay Rate Type Hourly Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years. Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics. Proud to be highest-ranked healthcare employer on the Forbes Best-In-State Employers, 2025 Iowa list. Talent Tuesdays An open-house hiring event at Mercy Cedar Rapids - 11:00 a.m. to 1:00 p.m. every Tuesday We welcome the chance to meet with you and share our current opportunities, including information on our exciting sign-on bonuses for select positions! Mercy Cedar Rapids is a growing healthcare system, rooted in purpose and driven by people - like you. We care for those who care for others with competitive pay and generous benefits. But we don’t just offer jobs, it’s the sense of community and shared purpose – our dedication to caring for the sick - that really sets Mercy apart as an employer. No appointment necessary – just bring your résumé! The Mercy Touch® — it’s compassionate people taking care of patients and each other. And, at Mercy Cedar Rapids, there's something for anyone who wants to have an influence on their community and grow their career. We are proud of our mission-centered culture and our employees enjoy growth opportunities, supportive team members, a generous benefits package and more. If you don't see the position you're looking for - or if you're not sure what you're looking for, we invite you to join our Talent Community to stay informed about future opportunities! Apply tot his job Apply To this Job