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The Precertification Specialist 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.
- 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
- Education Requirement
- Required: High School Diploma or GED equivalent
- Preferred: Certification or vocational training
- Experience Requirement
- Required: Minimum of one year previous clerical experience
- Preferred: Minimum years of relevant experience 2-4
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