Preregistration Specialist III

Description Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? Summary: The Preregistration Specialist III possesses an in-depth knowledge of insurance plans and policies in regard to financially clearing inpatient and outpatient-based procedures. The Pre-Registration Specialist III is responsible for insurance verification, benefit obtainment, and precertification for all scheduled outpatient surgical procedures, inpatient admissions and high dollar and high complexity advanced practice-based settings and outpatient hospital departments via telephone and online tools. The incumbent is also responsible for informing patients of any and all out-of-pocket expenses, including copays, coinsurances, and deductibles with the intent to collect and document these financial liabilities. The incumbent will work collaboratively with scheduling, financial counseling, and registration staff members to ensure patient wait times are minimized on the day of service. This individual participates and assists with training and mentoring staff members according to the organization's training programs. (HUP - Preservice - Centre Square West Tower - 1500 Market Street) Responsibilities: Access assignments via work queues to review insurance information registered for accuracy and completeness and places Business Office Review on each account in order to clear cases for surgery. Contacts insurance carrier and/or reimbursement sources via telephone and/or electronic tools to verify eligibility and obtain all applicable benefits pertaining to services being rendered. Provides required clinical and demographic information to payer to obtain the proper authorization/pre-certification for the services being rendered. Identifies potential quality and utilization concerns and refers to Management when appropriate and will follow-up with actions as indicated. Determine all patient out-of-pocket liabilities and contacts patients to coordinate collection of all out-of-pocket liabilities. Calculates patient's remaining balances and refers to the Patient Financial Advocate to finalize the method of resolving the patient liability through point of service collections, payment plans, or other arrangements. When applicable, refers to Financial Counseling appropriately when the patient has limited benefits or patient is uninsured. Meets on a regular basis with Management and communicates clearly the progress and status of all assigned functions and assists in projects for the department to enhance patient care and quality assurance. Exercises complete patient confidentiality in all dealings with patient information and demonstrates an awareness of patient/employee safety when carrying out daily responsibilities of their position. Education or Equivalent Experience: H.S. Diploma/GED and 7+ years' work experience in Patient Access or Medical Billing, including 5+ years minimum of Pre-Certification experience is required. Or Associate of Arts or Science degree in a Health-related field and 5+ years 5+ years minimum of Pre-Certification experience is required. We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law. REQNUMBER: 219761

Created: 2024-10-19