Pre Cert/Pre Reg Spec
About The Position
The Pre-Reg/Pre-Cert Specialist identifies patients eligible for pre-registration, including new and returning patients. The specialist verifies patient identification and demographic and insurance information, enters information into registration systems, and completes pre-service collections and documentation when applicable. The role verifies coverage and benefits and obtains pre-certification, notifications, and authorizations for admissions and outpatient visits. For sponsored admissions, the specialist contacts patients’ employers and/or insurance companies to verify coverage and benefits and obtain benefit levels, patient liability, and billing addresses.
Requirements
- High school graduate or GED.
- Ability to perform the professional, clinical, or technical competencies of the assigned unit or department.
Nice To Haves
- One or more years of experience with Epic.
- One or more years of prior experience in pre-registration or prior authorization.
Responsibilities
- Work daily reports to identify patients who have not been contacted before service.
- Use worklists to pre-register and pre-certify hospital services.
- Conduct telephone interviews with patients as needed to obtain demographic information and third-party payer data for billing.
- Enter patient data into registration systems.
- Ensure the Medicare Secondary Payer Questionnaire (MSPQ) is completed when appropriate.
- Verify dependent eligibility, certificate and group numbers, copayment and deductible amounts, statement mailing addresses, and other details with third-party payers.
- Comply with Medicare, Medicaid, and other insurance rules and regulations.
- Work with clinics, hospital ancillary departments, and patient financial advisors on potential insurance coverage complications.
- Secure accounts according to departmental policy, including contacting patients, payers, and employers; referring uninsured and underinsured accounts to Financial Advisors; and taking other necessary actions.
- Immediately contact the provider office about restrictions that deny services, including inability to obtain pre-certification or participation in an agency lock-in program.
- Perform the professional, clinical, or technical competencies of the assigned unit or department and other duties as required.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
