Preadmission Review Assistant
Mount Auburn Hospital - Cambridge, MA
Principal Duties and Responsibilities
1. Screens, verifies, and precertifies third-party insurance
coverage on inpatient and selected outpatient accounts. Identifies
copayment and deductibles, explains self pay responsibilities to
patients and their families. Screens and explains free care
possibilities and helps patients complete forms, as necessary.
a. Receives and reviews booking sheets and schedules and ensures
that all appropriate demographic and insurance information is
captured. Notifies physician and/or specialty physician offices to
b. Verifies insurance coverage and precertifies all required
cases in a timely and accurate manner. Identifies self-pay
responsibilities, copayment, deductible and coinsurance, discusses
with patients, and enters information on financial screen in the
c. Reviews previous days admission/observation activity, in the
computer, for completeness and accuracy and makes final edits as
necessary. Provides the necessary follow-up with physicians,
nursing units, patients, etc., to insure account is ready for
billing. Provides necessary comments on accounts in ADM and BAR
d. Understands and follows contract related information,
regulatory information and hospital credit and collection
2. Provides an assortment of functions related to self-pay or
free care accounts.
a. Estimates hospital charges for elective or urgent self-pay
accounts, and arranges for co-payments, deductible and deposits to
be collected. Comment on account any payment received in ADM and
b. Reviews free care guidelines with patients, and refers
patients to the Financial Counselors office or Social Services, as
c. Involves the manager in problem cases, in a timely manner,
providing thorough and specific information.
d. Defers cases with the permission of the manager and the
admitting primary care and/or specialty physician as necessary.
3. Answers all internal and external telephone calls to
Preadmission Review. Acts in a manner that fosters exceptional
interpersonal relations, and represents the hospital in a positive
manner while providing information to callers.
a. Answers a variety of financial-related inquiries in a
professional manner, identifying oneself and the department at the
start of each call.
b. Utilizes the utmost discretion when releasing any information
by telephone. Seeks advice of management when unsure.
c. Receives and distributes messages or transfers calls as
d. Provides specific follow-up to all calls or OA messages 100%
of the time.
4. Maintains an updated knowledge of specific preadmission and
insurance requirements. Keeps abreast of hospital/departmental
policies and procedures.
a. Reads and understands all insurance updates and requirements,
and incorporates changes into workflow. Utilize eligibility devices
supplied by insurers and use of the internet to verify eligibility
b. Acts as a resource to a variety of internal and external
c. Responds well to constructive criticism and attempts to make
changes based on input.
d. Maintains a working knowledge of all preadmission review
functions by being cross-trained.
e. Contributes constructive ideas to improve department
5. Provides assistance with the orientation and training of new
6. Assists in the care and maintenance of departmental equipment
and supplies, and notifies manager of any equipment malfunctions or
unsafe working conditions. a. Maintains a safe and secure work
environment 100% of the time.
7. Enhances professional growth and development by attending
hospital continuing education programs, listed under "Development
Objectives." Attends hospital inservices as required.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED
1. High school diploma, or equivalent, with two years of
experience in a hospital financial setting required, with a
thorough knowledge of preadmission review, credit and collection,
third-party billing requirements, and free care regulations.
Previous experience in verification for radiology procedures
preferred. Typing skills to utilize computer systems and
2. Strong interpersonal, written, and verbal communication
skills to deal professionally, courteously, and tactfully with
patients, patients' families, and all levels of hospital staff, as
well as a variety of outside business contacts.
3. Strong analytical ability to review and resolve problems
4. Demonstrated ability to work independently, and pay close
attention to detail, for a high level of accuracy nearly 100% of