Job Description

The Precertification Specialist I is responsible for verifying patient demographics and insurance benefits, assuring authorizations for service are in place, and informing patient of estimated payment amount. The Precertification Specialist I maintains a resource schedule and acts as a liaison with the patient, provider, physician, and insurance companies.



Ensures completeness and integrity of patient registration + Verifies and documents patient demographics, guarantors, and insurance information
+ Validates correct insurance at the time of registration and maintains a 4% or less error rate
+ Completes the pre-admission processes specific to assignment
+ Monitors schedules of assigned areas for added tests or procedures
+ Documents all accounts with pertinent information not limited to follow-up needed by hospital personnel
Performs financial processes and communicates patient's responsibility + Creates estimates of charges based on available information and collects pre-payments when necessary
+ Communicates financial options to patients prior to testing with possible referral to Financial Counselors
+ Screens testing urgency based on patient's ability to pay
+ Balances cash sheets and audits
+ Assures the MHG financial policy qualifications are met
+ Monitors authorization status and alerts Provider Staff or Precertification Specialist II if not received at least 3 days prior to date of service
+ Obtains copies of authorizations for non-MHG providers to receive reimbursement for MHG
+ Communicates with provider to modify testing/procedure orders to a medically necessary diagnosis based on payer guidelines

Education Requirement

Required: High School Diploma or GED equivalent

Experience Requirement

Required: Minimum of one year previous clerical experience


Knowledge of:


Admitting procedures, insurance coverage and billing requirements General office procedures and equipment Billing and collections regulations
Skills in:


Proficiency with general office equipment and Microsoft office applications Preparing and maintaining records, files, and reports Data entry with minimal errors
Ability to:


Work independently as well as with a team Communicate effectively in both oral and written forms Multi-task and prioritize
Work Environment and Physical Requirements:


* Work is generally performed in a hospital environment. Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.