Precertification Specialist I - Pre-Access - Days

Memorial Hospital at Gulfport•Biloxi, MS

6d•Onsite

About The Position

The Precertification Specialist I is responsible for verifying patient demographics and insurance benefits, assuring authorizations for service are in place, and informing patient of estimated payment amount. The Precertification Specialist I maintains a resource schedule and acts as a liaison with the patient, provider, physician, and insurance companies.

Requirements

High School Diploma or GED equivalent
Minimum of one year previous clerical experience
Knowledge of: Admitting procedures, insurance coverage and billing requirements
General office procedures and equipment
Billing and collections regulations
Skills in: Proficiency with general office equipment and Microsoft office applications
Preparing and maintaining records, files, and reports
Data entry with minimal errors
Ability to: Work independently as well as with a team
Communicate effectively in both oral and written forms
Multi-task and prioritize

Nice To Haves

Certification or vocational training
Minimum years of relevant experience 2-4

Responsibilities

Ensures completeness and integrity of patient registration
Verifies and documents patient demographics, guarantors, and insurance information
Validates correct insurance at the time of registration and maintains a 4% or less error rate
Completes the pre-admission processes specific to assignment
Monitors schedules of assigned areas for added tests or procedures
Documents all accounts with pertinent information not limited to follow-up needed by hospital personnel
Performs financial processes and communicates patient's responsibility
Creates estimates of charges based on available information and collects pre-payments when necessary
Communicates financial options to patients prior to testing with possible referral to Financial Counselors
Screens testing urgency based on patient's ability to pay
Balances cash sheets and audits
Assures the MHG financial policy qualifications are met
Monitors authorization status and alerts Provider Staff or Precertification Specialist II if not received at least 3 days prior to date of service
Obtains copies of authorizations for non-MHG providers to receive reimbursement for MHG
Communicates with provider to modify testing/procedure orders to a medically necessary diagnosis based on payer guidelines