Pre Registration Specialist Hem Onc

Responsibilities:

• Demonstrates professionalism and sensitivity in all patient/caregiver interactions. Observes and proactively acts to give directions, to answer questions or to provide information or reassurance regarding billing and financial matters as necessary.
• Review chemo schedule in advance and determines patients insurance requirements for pre-cert, coverage limitation and determine necessary action prior to patient arrival.
• Provide required clinical and demographic information to payer to obtain precertification and assure reimbursement
• Interact with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement.
• Verifies insurance eligibility and insurance data to determine coverage and benefits for services being performed. Obtains and verifies prior authorization and referrals for services being performed, documenting the prior authorization/referral information in EPIC. Obtain authorizations from carriers for infusion services. Confirm that the required precert/authorization information is correctly listed in EPIC.
• Conducts screening of the diagnosis and infusion requested to determine if the diagnosis supports the medical necessity. When necessary, secures a physician’s order/script or updates to physician’s order script, with ICD10 Codes and/or a narrative diagnosis, procedure, and physician’s signature to support the medical necessity of testing being performed.
• Enter and reconcile daily infusion charges in to EPIC
• Keeps manager aware of potential issues / problems as they arise
• Responsible to solve billing problems and knowledge of medical terminology
• As needed or requested, may perform patient services associate duties, such as scheduling patients for appointments or tests, patient check in or out duties.

Credentials:

Education or Equivalent Experience:

• Associate of Arts or Science
• Some college related to healthcare, business or human services.
• H.S. Diploma/GED (Required)
• 4+ years Has held position of responsibility for physician billing operations and accounts receivable management. 4+ years Specific knowledge of precertification requirements, CMS medical necessity requirements, third party billing processing procedures is ideal. Experience in the insurance industry or in an academic medical center highly preferred, as well as general knowledge of insurance company procedures and the dynamics of health care systems preferred.