Pre-Reg Pre-Cert Specialist
About The Position
The Pre-Reg/Pre-Cert Specialist identifies patients eligible for pre-registration, including new and returning patients. The specialist verifies identification and ensures demographic and insurance information is accurate and entered into the registration system. The role 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 insurance companies to verify coverage and benefits, benefit levels, patient liability, and billing addresses. The specialist works daily reports and worklists to contact patients before service, conducts telephone interviews to gather information needed for billing, and works with clinics, hospital ancillary departments, and patient financial advisors to address potential coverage complications. The position also secures accounts according to departmental policy and promptly notifies provider offices of restrictions that could prevent services.
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 and worklists to identify and contact patients who have not been reached before service, and pre-register or pre-certify hospital services.
- Conduct telephone interviews as needed to collect demographic information and third-party payer data 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 coverage details with third-party payers.
- Comply with Medicare, Medicaid, and other insurance rules and regulations.
- Coordinate with clinics, hospital ancillary departments, and patient financial advisors regarding potential insurance coverage complications.
- Secure accounts according to departmental policy, including contacting patients, payers, and employers; referring uninsured or underinsured accounts to Financial Advisors; and taking other necessary actions.
- Immediately notify provider offices of restrictions that may deny services, including inability to obtain pre-certification or an agency lock-in program.
- Perform the professional, clinical, or technical competencies of the assigned unit or department.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
