REGISTRATION & ELIGIBILITY SPECIALIST -

Patient Care

• Assist patients in locating departments
• Schedule and coordinate patient appointments
• Refer patients and families to appropriate services and resources

Customer Service

• Provide information and assistance to internal and external customers
• Ensure quality service and customer satisfaction

Data

• Perform data entry and research using various hospital system programs
• Enter various data into computer; verify data, make corrections and ensure accuracy

Registration

• Interview patients and/or families to obtain demographic, financial information and signatures as required
• Schedule new and follow-up appointments

Prior Authorization/Insurance

• Verify insurance coverage and benefits on patients needing an Auth
• Obtain authorizations for same day surgery, inpatient surgery, direct admits and any other pre scheduled stays or procedures
• Document Cerner with correct information; Scan all documents concerning authorization and reimbursement into Siemens document imaging
• May collect down payments for and copays for procedures
• Create Pre Admits in Cerner as appropriate
• Complete pre-screening process for specialty clinic appointments for referral and/or prior auth

Financial Assistance

• Interview patients and complete the application process for State/Government programs
• Maintain MOSAA certification with the State
• Interview and approve patients for UNM Hospital charity and discount programs
• Refer self-pay patients for financial assistance
• Make financial assistance appointments
• Determine and process eligibility for financial assistance (Including Medicaid, SCI, UNM Care, Commercial, Medicare, PHS/Indian Health Service, Salud, Self Pay)

Training

• Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices to include financial assistance programs
• Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication

Customer Relations

• Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospitals employees

Liaison

• Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/ coverage and prior authorizations

Front Desk

• Answer phones at front desk and assist walk-in patients as needed
• Provide after hours/weekend information desk coverage for the hospital
• Re-identify patients for Blood Bank and Health Information Management Department
• Organize folders for floor visits to patients
• Admit surgical patients and direct admits that present to the Admitting office
• Input all pre-admits for PALS and direct admissions as appropriate
• Log all admissions in the Admitting logs
• Accept and issue patient's valuables from patients and the Emergency Department Staff
• Perform floor visits to interview patients after a direct admit from the Emergency Department or the clinics

Cash

• Reconcile and complete cash reconciliation reports
• Balance and post payments, contractual allowances, and denials

Reports

• Obtain police reports when appropriate for billing information for Patient Financial Services
• Do the Census reports for PBX
• Work Medicare secondary payor report as assigned

Related Work

• Perform related duties and responsibilities as required

Signature

• Obtain proper signatures for Medicare Rights Consent for Treatment, financial forms for applying for assistance, and other forms as appropriate
• Assure that patient rights are distributed

Information

• Interview patients and/or family at time of admission, pre-admission or discharge to obtain accurate demographic, and financial information
• Update information on Hospitals computer system to ensure correct billing
• Register patients for the Laboratory and clinics after hours
• Provide billing information to Ambulance Services
• CODING - Assign ICD9 or ICD10, CPT codes as required by insurance companies in order to obtain authorization for services
• DOCUMENTATION- Send all pertinent medical documentation to insurance companies and other payors for approval
• Document final authorization in Cerner and scan all paperwork into Siemens scanning