Pre-Certification Coordinator - Sleep Lab - Merc 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.

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.