Pre-Reg Pre-Cert Specialist

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

Identify patients who qualify for pre-registration, including all new and return patients; Obtain identification to assure accuracy of demographic and insurance information and enter all information into the registration system; Responsible for pre-service collections and documentation when applicable; Verify and pre-certify, notify and authorize all admissions and/or outpatient visits; For sponsored admissions, contact patients' employer and/or insurance company to verify coverage and benefits, obtain benefit level, patient liability, and billing address; Work daily reports to retrieve all un-contacted patients prior to service and utilize worklists to pre-register/pre-certify hospital services; Conduct telephone interviews as needed to elicit demographic information and third-party payer data; Enter patient data directly into registration systems and ensure MSPQ is completed when appropriate; Verify with third-party payers dependent eligibility, certificate and group numbers, co-payment and deductible amounts, and statement mailing address; Comply with Medicare/Medicaid and other insurance rules and regulations; Work closely with clinics, hospital ancillary departments, and patient financial advisors regarding potential insurance coverage complications; Secure accounts per departmental policy, including contacting patients, payers, and employers, and referring uninsured and underinsured accounts to Financial Advisors; Contact provider office immediately of any restrictions denying services; Perform the professional, clinical and/or technical competencies of the assigned unit or department

Requirements

High School Graduate or GED

Nice to have

1 or more years of experience in Epic; 1 or more years of prior experience in pre-registration or prior authorization