About the position
Under the general supervision of the Supervisor and according to established policies and procedures, interviews and registers all patients (Inpatient and Observation Emergency and Outpatients) to obtain demographic third party insurance and related financial information and enters to on-line computer system. Initiates reviews and follows-up on patient accounts to ensure proper data collection for billing. Verifies all demographic and insurance information and obtains referrals as required.
Responsibilities
- Greets and directs all patients, families, and visitors in a prompt and courteous manner.
- Interviews patient or patient's representative to obtain complete and accurate third party health insurance and related personal/financial information.
- Completes registration and enters all data obtained into hospital computer system.
- Ensures patient is properly identified in system per department policy.
- Verifies demographic and insurance information by asking open-ended questions.
- Registers all patients (Outpatient ED, Inpatient, and Observation) by entering and/or verifying demographic insurance information into hospital information system.
- Completes documentation required on financial clearance reports as indicated by Patient Advocate or Pre-Registration Office.
- Utilizes online tools and/or telephone to verify coverage, determine level of benefits, and confirm that the primary care physician (PCP) matches the PCP recorded in hospital system.
- Contacts insurance carrier or company for missing information when necessary.
- Notifies Pre-Registration Office if coverage changes from pre-admit/pre-registration information.
- Identifies primary and secondary insurer and properly records insurance information in system.
- Completes lien forms upon determination that a liability exists.
- Gathers paper referrals from patients when required by the payer.
- Updates with the appropriate documentation.
- Contacts Financial Counselor/Pre-Registration Office if the insurance does not verify or if the patient does not have a referral when required by the payer.
- Utilizes system to determine self-pay balances for all patients.
- Uses reference tools to determine the expected payment due at time of service.
- Contacts Patient Financial Advocate to estimate expected payment on complex cases.
- Refers patients to Patient Financial Advocates if patients cannot meet the expected payment according to defined criteria.
- Collects co-payments as required per financial clearance or as required by third party payor or department policy.
- Documents collections in system, logs payments, and provides receipts per department policy.
- Explains consent, financial, and insurance forms to patients or designee and provides general hospital information regarding policy and procedure.
- Obtains patient signatures on all required forms to meet established hospital requirements.
- Verifies and updates all information.
- Makes bracelets and places bracelet on patients per department policies in accordance with patient identification policy.
- Utilizes hospital department scheduling and workflow reports to complete daily work.
- Communicates with service departments to obtain order information as required.
- Communicates with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at or prior to time of service.
- Asks patient for Advance Directive and includes with admission paperwork to go to nursing unit.
- Provides patients with information on Advance Directives if one is not prepared.
- Explains and has patient sign Advance Beneficiary Notice (ABN) as required.
- Completes medical necessity checks utilizing order entry system per hospital policy if not done during pre-registration process.
- Distributes financial aid applications when patient lacks evidence of adequate health insurance coverage according to established criteria.
- Refers patients to Patient Financial Advocate to assist patient with applications for medical coverage or Community Free Service and to establish payment plans.
- May pre-admit/pre-register scheduled outpatients and inpatients in hospital system.
- Contacts patients to verify demographics obtained at time of scheduling to complete any missing information.
- Verifies patient insurance coverage(s) both primary and secondary 'on-line' or by telephone.
- Obtains and verifies all other information required to secure payment through sources such as Worker's Compensation, MSP, Medicare, liability liens, etc.
- Ensures referrals are obtained and confirms accuracy of the PCP.
- Establishes level of insurance benefits and expected payment for selected services.
- Determines the patient's portion of payment when applicable and arranges for payment prior to the provision of services.
- Checks outstanding balances incurred for previous services prior to contacting patient and follows collection policy concerning prepayment prior to the provision of additional services.
- When appropriate, medical necessity verifications for services to be provided will be performed by the servicing department.
- May collect prepayments by phone or mail if there is enough time before admission or the provision of outpatient services.
- Refers insured patients who cannot meet their financial obligations to Patient Financial Advocates.
- Updates status of financial clearance activities in system.
- Prepares/assembles all necessary paperwork preparatory to the patient's arrival.
- Reviews/corrects third party payer eligibility reports.
- Completes real-time status transfers.
- At arrival at admission or in the patient's room, may complete any missing documentation and paperwork required from patients and/or family members.
- Coordinates with Nursing Department to assign patient beds in accordance with case management guidelines.
- Reviews newly assigned medical record numbers for duplication reporting all duplicates on appropriate form.
- Attends and participates in staff meetings.
- May be required as needed to provide coverage to numerous locations to meet patient/customer needs.
- Protects and preserves patients' right to privacy and confidentiality.
- Utilizes department equipment such as fax machine, phone, visa machine, laptop, PC, and other technology as developed.
- Performs other related duties as required to support the operations of the Department.
Requirements
- High school diploma or equivalent.
- Knowledge of medical terminology, third party insurance information, and standard office computer applications required.
- Knowledge of third party payer verification and authorization process preferred.
- Typing and data entry skills required.
- Customer Service Skills.
- Six to twelve months previous third party billing or hospital registration experience.
- Third party billing knowledge.
- Data entry skills and PC experience required.
