Stormont-Vail Healthcare Pre-Registration Representative (hospital based) in Topeka, Kansas

Summary:

Under direction, responsible for the processing of patient accounts from the point of scheduling to the completion of pre-bill editing. This responsibility includes scheduling the service, collecting and verifying the comprehensive data set, verification of insurance, insurance pre-certification, liability calculations, financial education and finalizing financial resolution with patients, financial assistance (HAP)and the identification and resolution of pre-bill edit failures following established policies and procedures, and in compliance with JACHO, Medicare, Payer contracts and other regulatory agencies.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Customer Service:

  • Supports the Stormont-Vail customer service policy and standards of excellence.

  • Exhibits a professional and pleasant demeanor when communicating with all customers and anticipates the patient’s need for clarification or additional information for their successful hospital visit.

  • Consistently uses diplomacy and respect both in person and when using the telephone, and performs effectively and professionally under stressful conditions.

  • Reminds patients to bring required information, referral forms, co-pays and deductibles, etc. at the time of service.

  • Instructs patients where and when to arrive, including directions on how to reach the facility from out of town and where to park.

  • Provides patient pre-procedure preparation instructions for appropriate services to ensure successful service.

  • Welcomes all customers to the facility in a friendly manner, offering assistance by giving directions or escorting patients to service areas.

  • Understands and follows the Stormont-Vail confidentiality policy, always maintaining the confidentiality of patients, co-workers, volunteers and physician offices.

Quality:

  • Receives calls, faxes, or computer-generated orders from physician offices to schedule patients for hospital services.

  • Accurately schedules services based upon the physician order and needs of the patient.

  • At time of scheduling, identifies services that require referrals or pre-authorizations and communicates those requirements to the ordering physician’s office.

  • At time of scheduling, identifies services where detailed and specific medical necessity information is required and obtains that information. Based upon that information, determines the type of financial education and required forms for that patient. (Medicare ABN, Blue Cross Limited Waiver or Financial Obligation.)

  • Coordinates the use of multiple resources such as Anesthesia, MRI, Hospitalists, and others as needed. Coordinates changes in resources if patient’s situation changes or in the case of rescheduled services.

  • Reschedules and cancels patient appointments as requested by the patient or physician offices.

  • Coordinates with service areas to schedule add-on appointments as requested by physician offices.

  • Accurately selects the correct patient when scheduling services to avoid treatment and billing errors.

  • Collects/updates the comprehensive data set at the time of scheduling, validating patient information and determines in or out of network insurance status.

  • Reviews schedules and accurately prioritizes order of processing based on established criteria.

  • Reviews scheduled patients to determine if appropriate lab results are available prior to service. If lab results are not available, takes appropriate steps to obtain results.

  • Completes missing data from the comprehensive data set and validates information with patient prior to patient arrival for service.

  • Initiates Pre-Registration work according to establish procedures.

  • Identifies insurance sources, collects and documents detailed and accurate insurance information in a timely manner.

  • Identifies managed care provisions and follows up with appropriate parties to resolve outstanding issues.

  • Obtains patient estimated charges when appropriate and calculates patient liabilities for requested services.

  • Negotiates financial resolution through proper sequencing of resolution options and patient’s ability/willingness to pay.

  • Identify financial assistance screening (HAP) when applicable.

  • Collates all information and paperwork, including face sheets, pre-authorizations, referrals, Medicare ABN and others in preparation for patient’s arrival and determines patient arrival status (express verses regular processing).

  • Collect, receipt and document patient payments according to established procedures.

  • Explain patient information (i.e., advanced directives, patient bill of rights, treatment consents, release of information,), identify and obtain proper signatures.

  • Determine and explain financial impact to patient of the Medicare ABN, Blue Cross Financial Waiver, Financial Obligation and others.

  • Screen registrations for sensitive diagnosis and obtain special release according to established hospital policy.

  • Continues time of service financial monitoring as applicable.

  • Applies advanced technical billing knowledge to track and resolve pre-service/service data edits. Clears all applicable comprehensive data bill edits in system.

  • Screens initial self-pay claims and sends to patient for payment according to negotiated financial resolution.

  • Monitor reports for special procedures requiring extra diagnosis codes or specialized financial education.

Teamwork:

  • Attends and participates at departmental team meetings, workgroups and other hospital educational programs.

  • Accommodates and supports the changes required to meet departmental and organizational goals and customer needs.

Communication/Interpersonal Relationships:

  • Establishes productive working relationships with those contacted in the course of work.

  • Recognizes volunteers as team members by delegating meaningful duties and demonstrating appreciation for their service.

  • Notifies appropriate department staff of the scheduling of specialized services in a timely manner to ensure staff and supplies are available at the time of service.

  • Notifies Registration of newly scheduled same day add-on services to ensure patient is registered in an efficient and timely manner.

Financial Viability:

  • Identifies access issues and assists in implementing an improvement plan.

  • Properly utilizes resources when scheduling to reduce waste and maximize productivity.

Personal Development:

  • Attends external seminars for personal growth and development and shares pertinent information with other team members.

  • Completes the annual mandatory in-services and other conditions of employment requirement.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

  • Two years experience in a clinical healthcare setting such as physician’s office or hospital relating to patient financial services, patient registration, patient scheduling or related healthcare experience, required.

  • Associates Degree or equivalent undergraduate hours, preferred.

  • Knowledge of medical terminology is preferred.

  • Knowledge of computers and MS Windows applications, required.

  • Keyboarding skill or typing skill of at least 30 WPM, required.

  • Knowledge of major third party payers and contracts.

  • Excellent customer service skills.

  • Excellent interpersonal and communication skills and the ability to exhibit patience. Good math and analytical skills.

  • Ability to work productively as part of a team.

  • Ability to negotiate and problem solve independently.

  • Ability to prioritize and handle multiple tasks.

  • Ability to make independent decisions regarding work prioritization/coordination.

  • Understanding of medical/clinical treatment processes.