Job Description

HYBRID: This is a hybrid position and must be located within 100 miles of any of the Mayo Clinic campuses for on-site expectations based on business needs.

The Precertification and Authorization Call Center Representative is an intermediate-level role responsible for supporting referral, precertification, and prior authorization workflows within a high-volume call center environment This position serves as a key point of contact for insurance payers, physician offices, and patients, facilitating timely communication and coordination throughout the authorization process. While team members do not directly initiate or submit authorizations, they provide critical operational support by managing inbound calls, addressing inquiries, gathering and communicating necessary information, and coordinating next steps with appropriate departments and clinical practices Team members support more than 23 Prior Authorization specialty skills, requiring the ability to navigate diverse workflows, systems, and departmental processes while adapting to varying customer and authorization needs. Success in this role requires strong communication and customer service skills, adaptability, attention to detail, sound judgment, and the ability to effectively manage competing priorities in a fast-paced environment. Team members are expected to consistently meet established quality, productivity, and compliance standards while maintaining a positive experience for both internal and external customers. To support efficient and effective operations, team members are expected to maintain an average productivity rate of 6.5 calls per hour while demonstrating professionalism, accuracy, responsiveness, and exceptional customer service. Performance expectations include adherence to quality assurance standards, regulatory and compliance requirements, and departmental procedures. Ultimately, success in this role requires effectively balancing productivity with accuracy, customer satisfaction, timely resolution, and operational excellence while contributing to broader departmental goals and service standards.

High School Diploma or GED and 2+ years of relevant experience required

OR

Bachelor’s degree required

Additional Requirements include:

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 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.