As our Patient Registration Specialist, you will ensure a positive patient experience through excellent customer service during registration, insurance verification, benefit analysis, and financial clearance processes.
Every day, you will identify patients, financially clear them across pre-registration to discharge, and counsel them on financial liability. You will verify payer sources, refer to alternative payment assistance programs, and accurately capture all demographic and insurance information for appropriate reimbursement. You will also determine and collect patient financial liabilities or arrange payment plans, serving as a primary information source for patients and families on policies and rights.
To be successful in this role, you will possess exceptional customer service and communication skills, meticulous attention to detail in financial processes, and a strong understanding of insurance and payment assistance.
- FUNCTIONS AND RESPONSIBILITIES Verification, Authorization, and Compliance
- Interviews patients to obtain, clarify and verify all demographic and insurance information, not previously gathered, and determines status of financial clearance, as needed.
- Identifies old, outstanding patient liabilities and calculates patient liability for proposed services in order to determine with patient how to resolve existing and projected liabilities and collects monies, as appropriate.
- Provides referral to external agencies and/or third party vendors, which provide financial assistance for medical care, through various government programs.
- Provides information and assists patients with the completion of the Payment Assistance application.
- Analyzes patients' ability to meet financial obligations and sets up appropriate payment plans.
- Identifies patients with special financial circumstances to assist in resolving current and future liabilities.
- Provides on-site customer service for walk-in patients with billing-related questions.
- Acts as an information resource for Dignity Health personnel, who are seeking answers to financial concerns for their patients.
- Works closely with and provides assistance to other departments, including Case Management, Health Information Management, Social Service, Physicians services, related to information on insurance coverage.
- Escalates accounts appropriately to Patient Access leadership where financial clearance is in jeopardy.
- Knowledgeable of, and administers the terms of the delay/defer policy as necessary by escalating accounts appropriately to Patient Access leadership
- Interviews self-pay patients to identify potential eligibility for government aid and/or other payer sources, including Medi-Cal/Medicaid presumptive eligibility. Follows appropriate policy and/or refers to eligibility vendor
- Understands and follows the Delay/Defer policy and escalates accounts that do not meet financial clearance requirements to Patient Registration leadership immediately
- For patients who qualify, offers a flat rate discount based on estimated charges, percent of reimbursement, and/or hospital specific policy and procedure.
- Thoroughly and accurately documents the conversation with the patient regarding financial liabilities, agreement to pay and/or payment assistance.
- 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.
- 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.
- Responsible for reviewing assigned accounts to ensure accuracy, and to ensure require documentation is obtained and complete.
- Financial Processing and Assistance
- Ensures complete, accurate and timely entry of insurance information into legacy ADT system, either at the time of service or during pre-registration/pre-admission.
- Collects, enters and completes corrections of required data into the legacy ADT system with emphasis on accuracy of demographic and financial information in order to ensure appropriate reimbursement for services for inpatients and outpatients at the time of service or during pre-registration/pre-admission.
- Explains the CHW Payment Assistance program fully, and directs them for further assistance, as necessary, either before or at the time of service.
- Identifies appropriate forms for patient/guarantor signature and obtains these signatures.
- 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.
- OTHER DUTIES
- Understands and follows the Cashier policy and procedures.
- When collecting patient payments, follows policy and procedure regarding applying payment to the patient's account and providing a receipt for payment.
- 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 patient's valuables following proper procedure.
- Works with physician offices and clinical areas to collect and share patient information, and to update these stakeholders on changes in patient registration requirements, processes and program.
- 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.
