Pre-Certification Coordinator Sleep Lab Mercy Hospital STL

The Pre-Authorization Coordinator manages the complete front-end patient experience and revenue cycle operations. This hybrid role handles front-desk patient intake check-in/check-out and scheduling alongside complex
insurance verification pre-certifications pre-authorizations and referral management. This position ensures exceptional patient service accurate clinical scheduling and timely payer approvals to optimize practice workflows and prevent financial denials.

Essential Duties and Responsibilities
Patient Services & Front Office (PSR Tasks)
Patient Intake: Greet patients warmly execute check-in/check-out procedures and verify accurate demographic information.
Appointment Scheduling: Coordinate schedule and reschedule patient appointments utilizing EHR scheduling workflows.
Co-Pay Collection: Collect co-payments past due balances and self-pay fees at the time of service issuing accurate receipts.
Phone Management: Answer incoming multi-line phone calls route messages to clinical teams and address patient inquiries promptly.
Check-Out Procedures: Process patient check-outs schedule necessary follow-up visits and distribute summary documentation.
Pre-Certification & Financial Coordination
Insurance Verification: Confirm patient eligibility benefit levels and policy details prior to scheduled appointments.
Prior Authorizations: Submit track and secure pre-certifications pre-authorizations and pre-determinations for medical/surgical procedures.
Referral Management: Review and coordinate incoming and outgoing clinical referrals according to insurance guidelines.
Payer Communication: Connect with insurance company representatives to resolve coverage issues review policies and track pending approvals.
Data Entry & Management: Update authorization codes effective dates and policy boundaries accurately within office-management software.
Clinical Review: Screen patient records to ensure documented medical necessity mirrors payer authorization rules.
Patient Financial Counseling: Communicate out-of-pocket responsibilities network status and authorization delays clearly to patients.
back-office administrative tasks simultaneously.

Education: High school graduate or equivalent.

Experience: Two-year minimum experience working with healthcare insurance billing and coding.

Certifications: Computer skills: word processing spreadsheet (Word Excel) EPIC. Excellent written and verbal communication skills. Knowledge of current coding for CPT/ICD-10/HCPS. Medical terminology.

Preferred Certifications: Certification as Coding Specialist preferred.
Preferred Other:

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 youll help shape the future of healthcare through innovation technology and compassion. As we grow youll grow with us.