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 obtains identification to ensure demographic and insurance information is accurate and enters patient information into the registration system. The role also handles pre-service collections and documentation when applicable, and verifies, notifies, and obtains authorization for admissions and outpatient visits. For sponsored admissions, the specialist contacts employers and/or insurers to verify coverage and benefits, benefit levels, patient liability, and billing addresses.
Requirements
- High school graduate or GED.
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 and retrieve patients who have not been contacted before service.
- Use worklists to pre-register and pre-certify hospital services.
- Conduct telephone interviews as needed to collect demographic information and third-party payer data required for billing.
- Enter patient data into registration systems and ensure the MSPQ is completed when appropriate.
- Verify dependent eligibility, certificate and group numbers, copayments, deductibles, statement mailing addresses, and other information 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 notify provider offices of service restrictions, including inability to obtain pre-certification or agency lock-in programs.
- Perform the professional, clinical, and/or technical competencies required by the assigned unit or department.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
