Patient Precertification Associate

3 weeks ago

McLean, United States Medstar Full time

Schedule: Monday-Friday, 8:00am-4:30pm

Job Summary:

MedStar Health is looking for a Patient Precertification Associate to join our team at MedStar Medical Group - McLean, VA Infusion Center

As a Patient Precertification Associate, you will c oordinate all the functions and activities related to patient pre-certification/authorization including, accurate and complete patient registration in the approved organization electronic scheduling and billing systems and on-site insurance verification.

Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the ""Healthiest Maryland Businesses"". Apply today and learn how MedStar Health can be your next great career move

Primary Duties:

  • Referrals/Authorizations: Verifies eligibility and conformance to the department and departmental managed care requirements and contracts. References the MedStar Managed Care Matrix and online Handbook as necessary. Obtains insurance referrals and pre-authorizations. Submits all referral information to necessary providers, as appropriate ; Assists with pre-authorizations of hospital admissions, procedures, medications and medical equipment.
  • Maintains ongoing communication with insurance companies to determine eligibility of benefits, deductible status, and to obtain precertification for office-based and other procedures. Educates and informs patients and families regarding verification status and issues related to deductibles, co-payments and balances; Responds to hospital staff and/or patient inquiries regarding referrals, authorizations, and scheduling in an efficient manner.
  • Registration: Searches the Enterprise Access Directory (EAD) to establish if the patient is new or existing. Follows guidelines to avoid duplicate medical record assignment; Obtains and/or verifies complete demographic and insurance information from the patient. Accurately enters complete demographics, insurance information and Financial Status Classification (FSC) / Hospital Patient Accounting Plan Code assignment into the approved organization's electronic scheduling and billing systems.
  • Pre-certification/Authorization & Billing: Responsible for resolving all outstanding Alerts on pending appointments within 48 hours of the scheduled appointment, to minimally include: Missing Referral, Missing Pre-certification/Authorization, Self-Pay Accounts, Eligibility Verification, Missing Demographic/Insurance Information, MedStar and/or department specific requirements, and Entering all relevant data, linking to the appropriate appointment/visit and ensures all required data elements are captured.


Qualifications:
  • Associate degree , or an appropriate combinatio n of education/training and experience .
  • Previous experience with computerized scheduling and registration systems .
  • Previous experience with an electronic health record system desire, especially GE centricity clinical or Aria .
  • 3-4 years' experience in a medical/clinical office with working knowledge of IDX/GE Centricity business preferred.


This position has a hiring range of $18.33 - $29.96

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