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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.
Job Responsibility:
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
Enters patient data directly into registration systems
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
Contact provider office immediately of any restrictions denying services, such as inability to obtain pre-certification or any lock-in program by any agency
Requirements:
High School Graduate or GED
1 or more years of experience in Epic
1 or more years of prior experience in pre-registration or prior authorization