Precert and Authorization Rep

This is a hybrid position and must be located within 100 miles of a Mayo Clinic campus for occasional on-site expectations based on business needs.

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.

The Transplant Precertification and Authorization Representative is a full-time, inbound call center role responsible for supporting transplant-related insurance and authorization inquiries. This position serves as a primary point of contact for incoming calls and is responsible for addressing questions and resolving issues in real time when possible.

Representatives are expected to take ownership of each call by identifying the concern, completing actions within their scope during the interaction, and documenting clearly for any required follow-up.

Responsibilities include:

• Managing inbound calls related to insurance verification, authorization status, and transplant-related inquiries
• Assessing caller needs and addressing concerns during the call to the extent possible
• Locating and sending required documentation (e.g., medical records) as appropriate to resolve the request
• Verifying insurance eligibility and transplant-related benefits when applicable
• Providing accurate, real-time information based on payer requirements and available data
• Documenting all actions clearly and completely to support downstream follow-up
• Identifying and escalating issues that cannot be resolved during the call
• Demonstrating working knowledge of the transplant financial clearance and/or authorization process

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.

Minimum Education: High School Diploma or GED required
Minimum Experience: 2+ years of relevant experience required OR Bachelor’s Degree required

Additional Requirements include the 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.

Preferred Qualifications

• Experience in an inbound call center, healthcare support, or related environment
• Ability to manage call volume while maintaining accuracy and professionalism
• Strong attention to detail with clear, thorough documentation skills
• Ability to assess situations quickly and take appropriate action within defined scope
• Effective communication skills with ability to explain information clearly
• Willingness and ability to learn complex transplant processes and workflows

Authorization to work and remain in the United States, without necessity for Mayo Clinic sponsorships now, or in the future (for example, be a U.S. Citizen, national, or permanent resident, refugee, or asylee). Mayo Clinic does not participate in the F-1 STEM OPT extension program.