Patient Precertification Associate

Overview

The individual in this position provides assistance to patients in the department. The person is responsible for coordinating all 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. These functions are performed in accordance with all applicable laws and regulations and Georgetown University Hospital's (GUH) philosophy, policies, procedures, and standards.

The individual in this position provides assistance to patients in the department. The person is responsible for coordinating all the functions and activities related to patient pre-certification/authorization, including but not limited to: accurate and complete patient registration in the approved organization electronic scheduling and billing systems and on-site insurance verification. These functions are performed in accordance with all applicable laws and regulations and Georgetown University Hospital's (GUH) philosophy, policies, procedures, and standards.

• Referrals/Authorizations:
  Verifies eligibility and conformance to Georgetown Physicians Group (GPG), GUH, and departmental managed care requirements and contracts. References the Med Star 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 into the approved organization electronic scheduling and billing systems.
• Re-certification/Authorization & Billing:
  Responsible for resolving all outstanding alerts on pending appointments within 48 hours of the scheduled appointment, including but not limited to missing referral, missing pre-certification/authorization, self-pay accounts, eligibility verification, and missing demographic/insurance information.
• Med Star and/or Georgetown University Hospital requirements:
  Enters all relevant data linking to the appropriate appointment/visit and ensures all required data elements are captured. Ensures data is entered into the Open Referrals Module, links data to the appropriate appointment/visit, and enters required data elements to ensure accurate billing information is submitted to the appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters them into the Appointment Data Form (ADF).
• Rescheduling:
  Establishes if the appointment needs to be rescheduled due to missing Referral or Authorization number. Works with departmental supervisor and/or clinician to determine medical necessity and if the appointment can be rescheduled. If appropriate, notifies the patient that the appointment needs to be rescheduled due to missing Referral/Pre-certification/Authorization.
• Financial Review:
  Reviews patient accounts with self-pay status. Confirms that patients understand the need to pay outstanding balances. Reviews rejected accounts to provide updated information to Physicians' Unified Billing Service (PUBS) and relays appropriate information regarding denied claims to patients when necessary. Where appropriate and…