Precertification Specialist

Olathe Health System, Inc.; Pavilion; On-site; CAD 68,000 - 88,000; Full time

Job summary

Olathe Health System, Inc. is seeking a Pre-Reg/Pre-Cert Specialist to identify patients for pre-registration and to manage pre-certification for admissions and outpatient services.

The role includes verifying demographics, insurance information, and payer data, and entering details into the registration system. The position also involves initiating pre-service collections, communicating with employers and insurers to verify coverage and benefits, and ensuring proper documentation is completed.

Qualifications

• High school diploma or GED required.
• 1+ year(s) of experience in Epic preferred.
• 1+ year(s) of prior registration or prior authorization preferred.

Responsibilities

• Works to identify patients eligible for pre-registration and pre-certification for admissions and outpatient visits.
• Verifies demographics, insurance information, and payer data; enters information into the registration system.
• Communicates with employers and insurers to verify coverage and benefits for sponsored admissions.
• Ensures MSPQ is completed when appropriate and notes patient liability, billing address, and payment requirements.
• collaborates with clinics and hospital departments to resolve insurance coverage issues.

Education

High School Graduate or GED

Tools

Epic

Job description

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.

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.

Position Title Precertification Specialist Olathe Medical Pavilion A Note: Schedule is Monday thru Friday 8:30am-5:00pm

Responsibilities And Essential Job Functions

• 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.
• 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.

Required Education And Experience

• High School Graduate or GED.

Preferred Education And Experience

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

Time Type

Full time

Job Requisition ID

R-57769

Important Information For You To Know As You Apply

• The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status. See also Diversity, Equity & Inclusion.
• The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link [e-mail].
• Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.