Pre-Reg Pre-Cert Specialist

The University of Kansas Health System

1d • Remote

About The Position

The Pre-Reg/Pre-Cert Specialist identifies patients who qualify for pre-registration, including new and returning patients. The specialist obtains identification to verify demographic and insurance information and enters that information into the registration system. The role also handles pre-service collections and documentation when applicable, and verifies and obtains pre-certification, notification, and authorization for admissions and outpatient visits. For sponsored admissions, the specialist contacts patients’ employers and/or insurance companies to verify coverage and benefits, determine benefit levels and patient liability, and obtain billing addresses.

Requirements

• High school graduate or GED.
• Ability to perform the professional, clinical, and/or technical competencies of the assigned unit or department.

Nice To Haves

• One or more years of experience in Epic.
• One or more years of prior experience in pre-registration or prior authorization.

Responsibilities

• Work daily reports and worklists to identify and contact patients before service and to pre-register and pre-certify hospital services.
• Conduct telephone interviews as needed to obtain patient demographic information and third-party payer data required for billing.
• Enter patient data directly into registration systems and ensure the MSPQ is completed when appropriate.
• Verify dependent eligibility, certificate and group numbers, copayment and deductible amounts, statement mailing addresses, and other coverage 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 regarding potential insurance coverage complications.
• Secure accounts according to departmental policy by contacting patients, responsible government and non-government payers, and employers; refer uninsured and underinsured accounts to Financial Advisors; and take other necessary actions.
• Immediately notify provider offices of restrictions that could deny services, such as inability to obtain pre-certification or an agency lock-in program.
• Perform the professional, clinical, and/or technical competencies required by the assigned unit or department; perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED