Job Abstract

?PURPOSE OF JOB:

Complete accurate pre-registration or registration for outpatient accounts, maintaining standards set for accuracy, positive patient experience and successful reimbursement for services.

ESSENTIAL FUNCTIONS:

Initiate/Complete an accurate patient registration.

Verify patient's insurance eligibility and benefits at or before time of service

Secure and/or verify authorization for service in accordance with payer guidelines and requirements.

Enter physician orders accurately into the ADM and ITS (Pre Natal registration only) modules, as required.

Identify and collect patient's financial responsibility.

JOB CRITERIA AND PERFORMANCE STANDARDS:

Pre-Register / Register Patients

Positively identify correct medical record and correct visit account.

Enter/ update complete demographic information.

Enter all physician-documented reasons for visit and ICD codes.

Verify patient's insurance eligibility and benefits

Determine correct insurance plan identification, with potentially multiple and differing contracts.

Verify eligibility and benefits using available resources and according to department protocols.

Screen for service capitation.

Complete Medicare Secondary Payer questions as required.

Document accounts with payer data.

Consistently resolve account errors in individual work que within prescribed timeframe; maintain individual/group RQA quality score at or above minimum standard.

Secure and/or verify authorization for service

Verify and/or secure specific related authorization requirement necessary to prevent later denial of charges by the carrier.

Monitor patient account until authorization has been verified.

Enter physician orders accurately

Enter physician orders into the ADM and ITS (Pre Natal registration only) Order Management modules, as required.

Check Medical Necessity and process ABN's (Advanced Beneficiary Notices).

Proactively contact physician offices for updated scripts when necessary.

Identify and Collect patient's financial responsibility

Collect patient financial responsibility. Calculate patient estimated cost as applicable.

Identify need for financial assistance and direct patients to appropriate resource.

?QUALIFICATIONS:

1. Education: High School or equivalent is required.

2. Experience: Hospital/Insurance experience preferred.

3. Other Skills: Excellent Customer Service Skills.

Negotiation and Problem Solving Skill.

Ability to prioritize and multi task.

Excellent Communication Skills.

Ability to work productively as a team.