Patient Registration Rep

CommonSpirit Health•Santa Maria, CA

3d•Onsite

About The Position

The Patient Registration Representative supports a positive patient experience by providing customer service throughout registration. The role identifies patients; collects and verifies demographic, insurance, and financial information; determines and collects patient liability; and explains hospital policies and patient rights. Accurate and timely registration, documentation, and insurance processing help support patient satisfaction, regulatory compliance, and reimbursement. The representative maintains knowledge of registration requirements for areas including Main Admitting, outpatient registration, the Emergency Department, Maternity, and Rehabilitation. Duties include entering and reviewing information in the ADT system, verifying patient identity and insurance coverage, obtaining signatures and required documents, providing applicable patient materials, and following downtime and EMTALA-compliant procedures. The role also handles specialized Emergency Department registration cases and assesses self-pay patients for presumptive eligibility when appropriate. The position verifies benefits, obtains referrals and authorizations, documents medical necessity and patient liabilities, requests payments, identifies outstanding balances, and arranges payment plans when needed. It explains the Payment and Billing Assistance Program, refers patients to registration specialists, and provides financial clearance services for self-pay patients before discharge or within 24 business hours. The representative follows applicable privacy, billing, payment-card, and regulatory requirements; may handle patient valuables if required by the facility; and works with physician offices and clinical areas on patient information and registration processes.

Requirements

High school diploma in General Studies or GED.
At least 1 year of experience in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, or another revenue-cycle-related role.
Experience requesting and processing financial payments.
Applicable education and/or training may be used to balance a lack of experience.

Nice To Haves

2 years of relevant experience preferred.

Responsibilities

Maintain current knowledge of registration requirements for Main Admitting, outpatient registration, Emergency Department, Maternity, and Rehabilitation areas.
Enter complete, accurate, and timely demographic and financial information into the ADT system, verify patient identity, review preregistered accounts, and correct errors.
Review assigned accounts for accuracy and required documentation; obtain patient or guarantor signatures and ensure required documents are scanned.
Complete and document applicable CMS requirements, including MSP, Important Message from Medicare, and Observation Notice issuance.
Provide patients and guarantors with applicable printed materials, including patient rights and responsibilities, HIPAA notices, and advance directive information.
Follow downtime procedures, including identifying the patient’s MRN, assigning a financial number, and entering information when the ADT system is restored.
Follow EMTALA-compliant registration steps in Emergency Department and Labor and Delivery areas, and follow protocols for special Emergency Department cases.
Assess self-pay patients for presumptive eligibility and initiate the process when appropriate; monitor and address tasks in the Mede/Analytics PAI tool.
Verify insurance benefits using electronic systems or by contacting payers; document coverage, deductibles, copayments, coinsurance, and policy limitations.
Obtain and document referrals, authorizations, and precertifications; submit admission notices when necessary and verify medical necessity for outpatient services.
Verify patient liabilities, calculate and request payments at registration, identify prior outstanding balances, and arrange payment plans when appropriate.
Document financial discussions and payment agreements, apply payments according to policy, provide receipts, and clarify and document shared financial responsibility.
Escalate accounts to Patient Registration leadership when needed, including accounts that do not meet financial clearance standards or require further review.
Explain the Payment and Billing Assistance Program to patients, refer patients to a Patient Registration Specialist when appropriate, and document referrals.
Provide financial clearance services to self-pay patients before discharge or within 24 business hours.
Support other hospital departments with insurance benefits and requirements and collaborate to meet third-party payer requirements.
Follow cashier procedures and handle credit card transactions in accordance with PCI-DSS standards and guidelines.
Inventory and store patient valuables according to procedure if required by the facility.
Coordinate with physician offices and clinical areas to collect and share patient information and communicate registration requirement, process, or program changes.