Precertification Specialist I - Pre-access - Days - FT

Memorial Hospital at Gulfport•Biloxi, MS

1d•Onsite

About The Position

The Precertification Specialist I verifies patient demographics and insurance benefits, ensures authorizations for services are in place, and informs patients of estimated payment amounts. The role maintains a resource schedule and serves as a liaison among patients, providers, physicians, and insurance companies. The specialist ensures registration information is complete and accurate, completes assignment-specific pre-admission processes, monitors schedules for added tests or procedures, and documents relevant account information and follow-up needs. The role also prepares estimates, collects pre-payments when necessary, communicates financial options, balances cash sheets, audits, and monitors authorization status. It works with provider staff to address outstanding authorizations and to modify testing or procedure orders to a medically necessary diagnosis based on payer guidelines. Work is generally performed in a hospital environment. Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond normal mobility and handling everyday objects and materials is needed.

Requirements

High school diploma or GED equivalent.
At least one year of previous clerical experience.
Knowledge of admitting procedures, insurance coverage, and billing requirements.
Knowledge of general office procedures and equipment.
Knowledge of billing and collections regulations.
Proficiency with general office equipment and Microsoft Office applications.
Ability to prepare and maintain records, files, and reports.
Ability to perform data entry with minimal errors.
Ability to work independently and as part of a team.
Effective oral and written communication skills.
Ability to multitask and prioritize.

Nice To Haves

Certification or vocational training.
Two to four years of relevant experience.

Responsibilities

Ensure completeness and integrity of patient registration.
Verify and document patient demographics, guarantors, and insurance information.
Validate correct insurance at registration and maintain an error rate of 4% or less.
Complete pre-admission processes specific to the assignment.
Monitor assigned-area schedules for added tests or procedures.
Document accounts with pertinent information, including follow-up needed by hospital personnel.
Create charge estimates based on available information and collect pre-payments when necessary.
Communicate financial options to patients before testing and refer them to Financial Counselors when appropriate.
Screen testing urgency based on the patient's ability to pay.
Balance cash sheets and conduct audits.
Ensure MHG financial policy qualifications are met.
Monitor authorization status and alert Provider Staff or a Precertification Specialist II if authorization has not been received at least three days before the date of service.
Obtain copies of authorizations for non-MHG providers to receive reimbursement for MHG.
Communicate with providers to modify testing or procedure orders to a medically necessary diagnosis based on payer guidelines.
Act as a liaison with patients, providers, physicians, and insurance companies.
Maintain a resource schedule.