New 
Patient Precertification Associate
 MedStar Health | |
 United States, D.C., Washington | |
 Oct 08, 2025 | |
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General Summary of Position Location: Georgetown University Hospital The individual in this position provides assistance to patients in the department. 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 in the approved organization electronic scheduling and billing systems and on-site insurance verification. These functions are performed in accordance with all applicable laws and regulations and Georgetown University Hospital's (GUH) philosophy, policies, procedures and standards. Primary Duties and Responsibilities Verifies eligibility and conformance to Georgetown Physicians Group (GPG), GUH and departmental managed care requirements and contracts. References the MedStar Managed Care Matrix and on-line Handbook as necessary. Obtains insurance referrals and pre-authorizations. Submits all referral information to necessary providers, as appropriate. Assists with pre-authorizations of hospital admissions, procedures, medications and medical equipment. Responds to hospital staff and/or patient inquiries regarding referrals, authorizations and scheduling in an efficient manner Will search the Enterprise Access Directory (EAD) to establish if the patient is new or existing. Follows guidelines to avoid duplicate medical record assignment. Obtains and/or verifies complete demographic and insurance information from patient. Accurately enters complete demographics, insurance information and Financial Status Classification (FSC) / Hospital Patient Accounting Plan Code assignment into the approved organization electronic scheduling and billing systems. Is responsible for resolving all outstanding Alerts on pending appointments within 48 hours of the scheduled appointment, to minimally include: Missing Referral Missing Pre-certification/Authorization Self Pay Accounts Eligibility Verification Missing Demographic/Insurance Information Enters all relevant data, linking to the appropriate appointment/visit and ensures all required data elements are captured. Ensures all relevant data is entered into the Open Referrals Module, links data to the appropriate appointment / visit and enters the required data elements to ensure that accurate billing information is submitted to the . appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters into the appropriate field in the Appointment Data Form (ADF). Where appropriate and within GUH guidelines, ensures collection of pre-payments/deposits due from the patient prior to service for elective cases and prior to the procedure for add-on cases. Where appropriate, reconciles operative log report to ensure all procedure fees have been submitted to PUBS. Reconciles Admissions, Discharges and Transfers (ADT) reports to ensure all inpatient visits have been submitted to PUBS. Completes daily deposit by completing Official Receipts and Journal Vouchers for processing payments. Maintains deposit logs and records. Researches and resolves any deposit discrepancies. At the end of each day or session, batches encounter forms, prepares Batch Entry Form and Batch Control Log to be sent to PUBS. Serves as liaison to PUBS and Patient Financial Clearance Unit (PFCU). Reviews rejection reports, ensures that corrective action is taken on all denied charges and that all charge sheets are resubmitted to PUBS for processing. Provides cross-coverage to Front Desk Check-in / Check-out position. Assists with payment and billing questions. Obtains basic clinical information from patients/callers to determine the appropriate appointment type and provider to which the appointment should be booked. 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. 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. Prints and distributes provider schedules to clinical team/management/administration as appropriate. Adhering to GPG and departmental policies and procedures, will access a patient's medical record / electronic health record (MR/EHR), for work related activities only, to complete proper patient documentation in the health record or to view needed information in the patient chart as necessitated by job role or function. Adheres to most current work flows or processes developed within GPG or specific Practice. Appropriately and accurately scans and indexes documents, using correct naming conventions, into patient EHR. Maintains and utilizes all office equipment such as computers, fax machines, telephones, etc. according to manufacturer's recommendations. Maintains competency in all electronic systems required for job functions. Reports computer malfunctions, software issues and/or problems to the Help Desk or appropriate staff. Follows care, documentation and cleanliness standards in the performance of job duties; Completes in-services and education on a timely basis; Interacts with other team members both on the unit and in other units in an appropriate and proactive way to benefit the patient; Observes proper elevator etiquette and courtesy: smiles and speaks to patients and visitors, does not discuss patient care and keeps voice low, gives right-of-way to patients and visitors; Minimum Qualifications
Experience
Licenses and Certifications
Knowledge, Skills, and Abilities
This position has a hiring range of $18.7 - $32.72 | |