Pre-Certification Coordinator - Sleep Lab - Mercy Hospital STL

Find your calling at Mercy! 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. Position Details: 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: 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. keyword(s): Sleep Lab