PATIENT REFERRAL SPECIALIST

Job Summary

The Pre-Admissions Coordinator performs pre-certification and verification on all eligible patients. This position requires a broad understanding of third-party reimbursement issues.

About the Role

• Collects new Inpatient/ Observation/ Outpatient surgical/ High Tech Radiology accounts daily to coordinate pre-certification and verification with insurance companies.
• Inputs detailed and accurate registration of patients, including telephone interviews on eligible patients.
• Maintains a thorough knowledge of hospital admitting policies as well as third-party private insurance reimbursement procedures and coverage so that pre-certifications can be performed accurately/timely.
• Completes retro-authorization requests and other assigned tasks for Patient Accounting Reps.
• Maintains confidentiality of all personnel and patient care and relations information.
• Participates in Strategic Quality Management for the department and organization.
• Participates in Customer/Guest Relations and Mandatory Education programs.
• Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations, and hospital policies and procedures.

Essential Functions

• Monitors Inpatient accounts to ensure that all releases and signatures have been obtained.
• Performs pre-certification of admission and verification of insurance coverage on inpatient admissions and eligible outpatient procedures so that insurance companies are notified, and denials are eliminated.
• Calculates estimates of patient balances on eligible scheduled procedures.
• Collaborates with physician’s offices/surgery department/Radiology departments to obtain patient information needed for pre-admission interview, to submit accurate billing, days prior to arrival at the hospital.
• Communicates closely with Utilization Review and Case Managers on IP admissions completing tasks requested.
• Participates in the rotation of on-call for the Emergency Room on weekends and holidays.
• Maintains confidentiality of all personnel and patient care and relations information.
• Participates in Strategic Quality Management for the department and organization.
• Participates in Customer/Guest Relations and Mandatory Education programs.
• Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations, and hospital policies and procedures.

Job Qualifications

• Education: High School graduate or GED equivalent.
• Licenses: None.
• Certifications: See Cardiopulmonary Resuscitation Certification Policy and Certifications/Education Requirements Policy.
• Experience: Prior medical office and/or hospital admitting experience including billing preferred. Prior customer relations experience required. Prior computer keyboarding and 10-key calculator experience required. Medical terminology knowledge preferred.