PRE-REG PRE-CERT SPECIALIST

Position Summary / Career Interest:

The Pre-Reg/Pre-Cert Specialist is responsible for identifying patients who qualify for pre-registration to include all new patients and all return patients. This position obtains identification to assure accuracy of demographic and insurance information and enters all information into the registration system. The Pre-Reg/Pre-Cert Specialist is responsible for pre-service collections and documentation when applicable. This role is responsible for verification and pre-certification, notification and authorization of all admissions and / or outpatient visits. For all sponsored admissions, will contact patients’ employer and/or insurance company to verify coverage and benefits, obtain benefit level, patient liability, billing address.

Responsibilities:

• Works reports daily according to duty specifications to retrieve all un-contacted patients prior to service.  Utilizes worklists to pre-register / pre-certify hospital services.
• Conducts telephone interviews as needed with patients to elicit demographic information and third-party payer data that will be needed for billing purposes.
• Enters patient data directly into registration systems.  Ensures that MSPQ is completed when appropriate.
• Verifies with third party payor dependent eligibility, certificate and group numbers, co-payment and deductible amounts, statement mailing address, etc.  Complies with Medicare / Medicaid and other insurance rules and regulations.
• Works closely with the clinics, hospital ancillary departments, and patient financial advisors regarding potential complications regarding insurance coverage.
• Secures accounts per established departmental policy.  This includes but is not limited to, contacting the patient, contacting responsible payers including government and non-government payers, contacting the patient’s employer, referring uninsured and underinsured accounts to the Financial Advisors, and taking any other necessary actions.  Contact provider office immediately of any restrictions denying services, such as inability to obtain pre-certification or any lock-in program by any agency. 

*Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.

*Note:  These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities.  Skills and duties may vary dependent upon your department or unit.  Other duties may be assigned as required.

JOB REQUIREMENTS

Required:

• High School Diploma or GED

Preferred:

• Epic experience
• Prior experience in pre-registration or prior authorization

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.