Obtain and verify appropriate personal, demographic and financial information for the purposes of ensuring (1) Quality patient care through proper patient identification and (2) maximal reimbursement for all billable clinical services rendered. (3) Scanning the appropriate identification documents into OnBase. Obtain EMTALA notification signature. (4) Notify clinical staff when patients present with critical condition. (5) Once verified places appropriate insurance information on account.
Analytical Skills
Analyze patient accounts; evaluate financial data for establishment of current accounts and documents comments to reflect actions taken regarding accounts to maximize reimbursement. Maintain knowledge of current HMO/PPO/Medicaid/Medicare/commercial insurance regulations and requirements. Requires working knowledge of Insurance Plans the Christ Hospital participates in. Determines all insurance coverage’s as primary, secondary, tertiary, etc. Completes required MSPQ questionnaires for all appropriate patients. Obtains and documents clinical referrals from other providers. Coordinates patients in need of financial assistance to pay for present and/or future services to appropriate Financial Counselor. Collects and deposits according to specified protocols, all required and mandatory insurance co-payments.
Initiates on-line verification of third party Insurance Carriers and Plan Administrators to verify patient benefits. Evaluates and prepares chart documentation to establish that Medical Necessity guidelines have been met. Prepares and completes documentation that establishes Medicare Compliance such as Medicare Secondary Payor Questionnaire and Advance Beneficiary Notice. Documents appropriate data in account doc and guarantor notes.
Clinical Skills
Processes Emergency and Obstetrics by notifying appropriate staff.
Answers and directs incoming calls from Physician’s office staff, ancillary departments and other facilities. Answers inquiries concerning hospital policies.
Compliance Skills
Obtains signatures for the visit for all revenue cycle documentation.
Prepares charts, collected forms and photocopies (insurance cards) and documentation. Distribute, witness by signature and collect patient advanced directive forms/information; referring patients to appropriate personnel to address specific questions as indicated. Provides patients with information about their rights and responsibilities and all other duties as assigned.
Communication/Interpretation Skills
Interviews patients and obtains, verifies and enters into database complete and accurate demographic and financial information. Assesses and updates information as it relates to each encounter. Determines financial plan and coverage priority. (Data collected directly impacts financial and clinical systems,)
Must maintain facility established productivity standards and Patient Accounts Quality Guidelines (i.e. 100% accuracy of 95% of all registrations).
Must communicate effectively and meet or exceed established customer service goals.
Education and Leadership Skills
Provides education and training/mentoring for other staff members. Attends department meetings and reviews procedural & process changes per facility specific guidelines.
KNOWLEDGE AND SKILLS:
Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.
EDUCATION: High School Diploma, Associates Degree preferred or equivalent combination education and experience.
YEARS OF EXPERIENCE: One to three years experience in Registration, Billing, Customer Service, or Managed Care Organization work environment. Must have/gain knowledge of the Hospital Medical Staff rules and infection control policies to be effective in this position.
REQUIRED SKILLS AND KNOWLEDGE: Analytical skills required to make decisions based on the facility and clinical situation at hand.
Computer Literacy – use of multiple systems
Epic, Passport, OnBase, Microsoft Office products and Midas.
Ability to use Internet Access and utilize third party payor systems for eligibility and verification.
Knowledge of health insurance coverage, requirements.
Excellent communication, problem solving skills, and ability to deal with customers who are often adversarial. Ability to be flexible, organized and function well in stressful situations. Ability to interact Independently to resolve Customer Service issues.
Must understand medical terminology and acuity levels.
LICENSES & CERTIFICATIONS:
Annual Registration Competency Review with 95% or greater score obtained.
Yearly STAT testing completed.
