| Position Description:|
Healthcare isnt just changing. Its growing more complex every day. ICD-10 Coding replaces ICD-9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And thats what fueled these exciting new opportunities.
Who are we? Optum360. Were a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, well leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.
If youre looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. Its an opportunity to do your lifes best work.
Employing excellent customer service skills, the Patient Registration Representative is responsible for ensuring a positive patient experience throughout the registration process.
- Appropriate patient identification
- Collecting accurate and thorough patient demographic data
- Obtaining insurance information and verifying eligibility and benefits
- Determining and collecting patient financial liability
- Referring patients to the Patient Registration Specialist as needed for assistance with financial counseling and/or clearance
- Maintains up-to-date knowledge of specific registration requirements for all areas, including but not limited to: Main Admitting, OP Registration, ED Registration, Maternity, and Rehabilitation units.
- Ensures complete, accurate and timely entry of demographic information into the ADT system at the time of registration.
- Properly identifies the patient to ensure medical record numbers are not duplicated.
- Responsible for reviewing assigned accounts to ensure accuracy and required documentation is obtained and complete.
- Meet CMS billing requirements for the completion of the MSP, issuance of the Important Message from Medicare, issuance of the Observation Notice, and other requirements, as applicable and Observation Notice, and other requirements, as applicable and documenting completion within the hospitals information system for regulatory compliance and audit purposes.
- Collects and enters required data into the ADT system with emphasis on accuracy of demographic and financial information in order to ensure appropriate reimbursement.
- Carefully reviews all information entered in ADT on pre-registered accounts. Verifies all information with patient at time of registration; corrects any errors identified.
- Identifies all forms requiring patient/guarantor signature and obtains signatures.
- Ensures all required documents are scanned into the appropriate system(s).
- Identifies all appropriate printed material hand-outs for the patient and provides them to the patient / guarantor (Patient Rights and Responsibilities, HIPAA Privacy Act notification, Advance Directive, etc.).
- Follows downtime procedures by manually entering patient information; identifying patients MRN in the MPI database, assigning a financial number; and, accurately entering all information when the ADT system is live.
- Follows EMTALA - compliant registration steps for both Emergency Department and Labor and Delivery areas.
- Assesses self-pay patients for presumptive eligibility and when appropriate, initiates the process.
- In the Emergency Department follows protocol for special cases, including but not limited to 5150, Sexual Assault Response Team (SART), Domestic Violence patients, Child Protective Services, incarcerated patients, Worker Compensation patients, auto accidents, animal bite reporting, etc as required.
- Monitors and addresses tasks associated with the Mede / Analytics PAI tool.
Verification, Authorization and Compliance:
- Follows approved scripting, verifies insurance benefits on all patients registered daily by using electronic verification systems or by contacting payers directly to determine the level of insurance coverage.
- Thoroughly and accurately documents insurance verification information in the ADT system, identifying deductibles, co-payments, coinsurance, and policy limitations.
- Obtains referral, authorization and pre-certification information; documents this information in the ADT system and submits notices of admission when necessary.
- Verifies medical necessity check has been completed for outpatient services. If not completed and only when appropriate, uses technology tool to complete medical necessity check and/or notifies patient that an ABN will need to be signed. Identifies payer requirements for medical necessity.
- Verifies patient liabilities with payers, calculates patients payment, and requests payment at the time of registration.
- Identifies any outstanding balance due from previous visits, notifies patient and requests patient payment.
- Sets up payment plans for patients who cannot pay their entire current co-payment and/or past balance in one payment.
- Thoroughly and accurately documents the conversation with the patient regarding financial liabilities and agreement to pay.
- When collecting patient payments, follows department policy and procedure regarding applying payment to the patients account and providing a receipt for payment.
- Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company. Ensures this information is clearly documented in the ADT system.
- When necessary, escalates accounts to appropriate Patient Registration leadership staff, based on outcomes of the verification process and patients ability to pay.
- Complies with HIPPA, PHI and its implications, ABN, MSP, EMTALA, etc. and other regulations which affect the registration process.
Financial Processing and Assistance:
- Understands and follows the Delay / Defer procedure and escalates accounts that do not meet financial clearance standards to Patient Registration leadership immediately.
- Explains the Payment and Billing Assistance Program to all patients regardless of financial concerns or limitations. Refers patients to Patient Registration Specialist as appropriate.
- Documents the referral to the Patient Registration Specialist in the ADT system.
- Provides financial clearance services to self-pay patients prior to discharge or within 24-business hours.
- Acts as resource to other hospital departments regarding insurance benefits and requirements and collaborates with other departments, as needed, to ensure proper compliance with third party payer requirements.
- Understands and follows the Cashier policy and procedures.
- Properly handles credit card transactions in accordance with PCI-DSS standards and guidelines. Will have access to both single card transactions as well as access to data from multiple transactions or reports and files containing bulk transactional information containing un-encrypted or un-redacted credit card information.
- If required by facility, inventories and stores patients valuables following proper procedure.
- Works with physician offices and clinical areas to collect and share patient information and to help update these stakeholders on changes in Patient Registration requirements, processes or programs.
- The above statements reflect the general details considered necessary to describe the essential functions of the job as identified, and shall not be considered as a detailed description of all work requirements that may be inherent in the position.