Entity: Clinical Practices of the University of Pennsylvania (CPUP)
Department: Dermatology
Location: 3535 Market Street
Hours: Hybrid
Summary:
The Pre-Registration Specialist reports to the Supervisor of Financial Clearance. This individual possesses an in-depth knowledge of insurance plans and policies in regard to financially clearing inpatient and outpatient based procedures. The Pre-Registration Specialist is responsible for insurance verification, benefit obtainment, and precertification for all HUP scheduled outpatient surgical procedures and inpatient admissions 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.
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 (Required)
- 3-5 years minimum of Pre-certification experience (Required)
- Associate of Arts or Science (Preferred)