Patient Precertification Associate

Status: Full-time, 40-hours per week
Schedule: Monday-Friday, 8:00am-4:30pm

Job Summary:

MedStar Health is looking for a Patient Precertification Associate to join our team at MedStar Health Outpatient Infusion Center - Chevy Chase!

As a Patient Precertification Associate, you will assist patients requiring precertification for services provided within and outside of a MedStar Ambulatory Care Center. The individual 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, on-site insurance verification, pre-service testing coordination and assisting in billing denial resolution. MedStar Ambulatory Services is committed to providing world-class, compassionate care to every patient, every time, at every touch point. All associates are accountable for their role in meeting patient experience standards.

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:

• Answers incoming calls from patients regarding pre-certifications and provides information regarding services, referrals, etc. Using standard forms or Electronic Health Record (EHR) system, records messages from patients, referring physicians, pharmacies, and other clinical areas and appropriately and accurately scans and indexes documents, using correct naming conventions, into patient EHR.

• Assists with pre-authorizations of hospital admissions, procedures, medications and medical equipment. Identifies patient's insurance, ascertains the MedStar Entities' contract participation status (Par vs. Non-Par) and communicates contract participation status to patient and reviews electronic billing information to ensure appropriate coding and preemptively resolves any possible billing errors prior to submission to PUBS.

• Communicates referral requirements, patient's financial responsibility and other pre-appointment information, as appropriate, including necessary procedure/examination preparations, e.g. NPO after midnight, according to departmental policies and procedures and coordinates patients' medication delivery from specialty pharmacies and receipt at the MedStar Ambulatory Care Center.

• Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.

• Demonstrates behavior consistent with MedStar Health's mission, vision, goals, objectives and patient care philosophy and adheres to MedStar Ambulatory code of Conduct and Compliance plan.

• Determines referral requirements, creates Referral in the approved organization electronic scheduling and billing system and links to appointment or updates ADF with Authorization / Pre-Certification number as appropriate. Ensures all relevant data is entered into the Open Referrals Module.

• 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, notify the patient that the appointment needs to be rescheduled due to missing Referral/Pre-certification/Authorization.

• Obtains missing pre-certification or authorization numbers and enters the appropriate field in the Appointment Data Form (ADF). Ensure all documents supporting authorization numbers have been scanned into the patient's electronic chart.

Qualifications:

• Associate's degree required.

• Knowledge of medical terminology required.

• Experience in a medical/clinical office.

• Previous experience with computerized scheduling and registration systems required.

• Previous experience with an electronic health record system desired, especially IDX/GE centricity clinical or Aria preferred.