Pre-Reg Pre-Cert Specialist

The University of Kansas Health System•Liberty, MO

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, enters information into registration systems, and handles pre-service collections and documentation when applicable. The role verifies coverage and benefits and obtains pre-certification, notification, and 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.

Requirements

High school graduate or GED.

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 to identify patients who have not been contacted before service.
Use worklists to pre-register and pre-certify hospital services.
Conduct telephone interviews as needed to obtain demographic and third-party payer information needed for billing.
Enter patient data directly into registration systems.
Ensure the Medicare Secondary Payer Questionnaire (MSPQ) is completed when appropriate.
Verify dependent eligibility, certificate and group numbers, co-payment and deductible amounts, and statement mailing addresses 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, including contacting patients, payers, and employers; referring uninsured and underinsured accounts to Financial Advisors; and taking other necessary actions.
Immediately notify provider offices of restrictions that may deny services, such as inability to obtain pre-certification or participation in an agency lock-in program.
Perform the professional, clinical, and/or technical competencies of the assigned unit or department.
Perform other duties as assigned.