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Precertification and Authorization Rep – Remote
Job Details
- 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.
Responsibilities
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.
Qualifications
High School Diploma or GED and 2+ years of relevant experience required
OR
Bachelor’s degree required
Additional Requirements include:
Prior Auth / Authorization, Cancer Services, Microsoft Office, Radiation Oncology, Insurance Verification, Appeals, and Pre Determination experience preferred.
Ability to read and communicate effectively
Basic computer/keyboarding skills, intermediate mathematic competency
Good written and verbal communication skills
Knowledge of proper phone etiquette and phone handling skills
Position requires general knowledge of healthcare terminology and CPT-ICD10 codes. Basic knowledge of and experience in insurance verification and claim adjudication is preferred. Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view. Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. Knowledge of Denial codes is preferred. Knowledge of and experience using an Epic RC/EMR system is preferred. Healthcare Financial Management Association (HFMA) Certification Preferred.
*This position is a 100% remote work. Individual may live anywhere in the US.
**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.
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.
Exemption Status
Nonexempt
Compensation Detail
$21.48 -$33.60/ hour
Benefits Eligible
Yes
Schedule
Full Time
Hours/Pay Period
80
Schedule Details
Rotating schedule (time listed are Central Time) Week 1 – 7:00am-3:30pm Week 2 – 8:00am-4:30pm Week 3 – 8:30am-5:00pm *All with a 30 minute lunch*
International Assignment
No
Site Description
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”. Mayo Clinic participates in E-Verify 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.
Recruiter
Ronnie Bartz
APPLY HERE: Precertification and Authorization Rep – Remote
Claims Examiner – Long Term Care (Remote)
Job Details
This position is responsible for examining routine and non-routine claims for one or more products and multiple series of contracts by evaluating the extent of liability within established guidelines. This position is accountable for analyzing claims to determine benefit/contract eligibility and processing claim transactions within specified dollars limits in compliance with state and federal regulatory standards, and NAIC (National Association of Insurance Commissioners) guidelines. Additionally, this position is a member of a team, actively partners with peers on meeting established service and quality standards, provides coaching and training to other Examiners and identifies opportunities for process improvements.Job Duties and Responsibilities
- Determine extent of liability on routine and non-routine claims and make final claim decisions within specified dollar limits. Contribute to accurate fraud detection and reporting by referring suspected fraud to appropriate staff for review according to established procedures.
- Analyze claim transactions and process payments utilizing various work flow, administrative, and LOB (Line of Business) systems, accurately and cost effectively according to contract provisions and in compliance with internal service and state and federal regulatory standards.
- Ensure high level of customer satisfaction by partnering with members, financial associates, doctors, providers, attorneys, police, vendors and other internal and external customers regarding claims, settlements and interpretation of policy provisions, which may include highly confidential information or complaints, often educating the recipient on products/benefits and regulatory requirements.
- Handle sensitive written and verbal communications. May be called upon to influence behavior via these communications.
- Actively participate in the development and implementation of business processes, standard operating procedures, documentation and other support materials required for unit operation. May also analyze data and offer remediation in response to audit inquiries or compliance examinations as determined by the Claims Consultant.
- Provide consultation to Associate Claims Examiners in helping to answer questions and make decisions on claims with a moderate level of complexity.
Required Job Qualifications
- High school required. College degree preferred.
- Minimum of 2 years relevant experience.
- Professional credentials preferred (e.g. LOMA, ICA).
- Intermediate knowledge of claim administration and operations as well as pertinent laws and regulations.
- Must possess strong interpersonal skills, as well as excellent verbal and written communication skills.
Other Critical Factors
- As part of Thrivent Financial’s hiring process, a verification of a candidate’s background will be made to complete the hiring process.
- May represent the company at depositions and court appearances.
Pay Transparency
Thrivent’s long-term growth depends on attracting, rewarding, and retaining people who are committed to helping others thrive with purpose. We accomplish this by offering a wide variety of market competitive compensation programs to attract, reward, and retain top talent. The applicable salary or hourly wage range for this full-time role is $24.06 – $32.56 per hour, which factors in various geographic regions. The base pay actually offered will be determined by a variety of factors including, but not limited to, location, relevant experience, skills, and knowledge, business needs, market demand, and other factors Thrivent deems important.
Thrivent is unique in our commitment to helping people to be wise with money and live balanced and generous lives. That extends to our benefits.
The following benefits may be offered: various bonuses (including, for example, annual or long-term incentives); medical, dental, and vision insurance; health savings account; flexible spending account; 401k; pension; life and accidental death and dismemberment insurance; disability insurance; supplemental protection insurance; 20 days of Paid Time Off each year; Sick and Safe Time; 10 paid company holidays; Volunteer Time Off; paid parental leave; EAP; well-being benefits, and other employee benefits. Eligibility for receipt of these benefits is subject to the applicable plan/policy documents. Thrivent’s plans/policies are subject to change at any time at Thrivent’s discretion.
Thrivent provides Equal Employment Opportunity (EEO) without regard to race, religion, color, sex, gender identity, sexual orientation, pregnancy, national origin, age, disability, marital status, citizenship status, military or veteran status, genetic information, or any other status protected by applicable local, state, or federal law. This policy applies to all employees and job applicants.
Thrivent is committed to providing reasonable accommodation to individuals with disabilities. If you need a reasonable accommodation, please let us know by sending an email to human.resources@thrivent.com or call 800-847-4836 and request Human Resources
APPLY HERE: Claims Examiner – Long Term Care (Remote)
