PT REGISTRATION SPECIALIST

Job Summary and Responsibilities

• Ensures a positive patient experience through excellent customer service during registration, insurance verification, benefit analysis, and financial clearance processes.
• Identifies patients, financially clears them across pre-registration to discharge, and counsels them on financial liability.
• Verifies payer sources, refers to alternative payment assistance programs, and accurately captures all demographic and insurance information for appropriate reimbursement.
• Determines and collects patient financial liabilities or arranges payment plans, serving as a primary information source for patients and families on policies and rights.

Functions and Responsibilities

• 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.
• Reviews assigned accounts to ensure accuracy, and to ensure required documentation is obtained and complete.
• 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.
• 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.

Job Requirements

• Required: High School Graduate General Studies and Minimum 2 years of experience working in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, and/or other revenue cycle-related role, upon hire or High School GED General Studies and Minimum 2 years of experience working in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, and/or other revenue cycle-related role, upon hire.
• Preferred: 3 years of experience working in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, and/or other revenue cycle-related role.
• Experience in requesting and processing financial payments.
• Experience in customer service, preferably in a healthcare environment.
• None, upon hire.