REGISTRATION & ELIGIBILITY SPECIALIST -

Department: Admitting - SRMC | FTE: 1.00 Full Time | Shift: Nights

About the Role

Perform pre-registration and registration functions for assigned area; verify insurance coverage eligibility and benefits; obtain authorization for admission; verify required referrals and/or prior authorization are in place; interview patients for outdated or missing demographics; handle professional and efficient phone calls via telephone ACD system in a call center setting; act as first contact for Persons in Custody of Law Enforcement Agency (PICLEA) as they arrive for care; screen patients for coverage and assist them in navigating financial options including UNMH or other UNM Health Systems financial assistance, NM Medicaid, or other State and Federal Programs. Advise, inform, and assist patients before and after their admission. Ensure adherence to hospital and departmental policies and procedures. No patient care assignment.

Responsibilities

• 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.
• Cash Handling - Reconcile and complete cash reconciliation reports; balance and post payments, contractual allowances, and denials.
• Training - Train registration and admitting personnel to ensure proper registration and knowledge of business practices, including financial assistance programs.
• Professional Development - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings, and workshops.
• Patient Care Support - Assist patients in locating departments; schedule and coordinate patient appointments; refer patients and families to appropriate services and resources.
• Information Collection - Interview patients and/or family at time of admission, pre-admission, or discharge to obtain accurate demographic and financial information; update information on hospital computer systems to ensure correct billing; register patients for the Laboratory and clinics after hours; provide billing information to Ambulance Services.
• Documentation and Signatures - Obtain proper signatures for Medicare Rights Consent for Treatment, financial forms for applying for assistance, and other forms as appropriate; ensure patient rights are distributed.
• Prior Authorization/Insurance - Verify insurance coverage and benefits; provide notification of admission and obtain authorization for emergency admits; obtain authorizations for same-day surgery, inpatient surgery, direct admits, and other pre-scheduled stays or procedures; provide pertinent medical history/documentation to insurance companies and other payors; document in Cerner with correct information; scan all documents concerning authorization and reimbursement into Siemens document imaging; collect down payments and copays for procedures; create Pre Admits in Cerner as appropriate.
• Eligibility Determination - Determine and process eligibility for financial assistance (including Medicaid, SCI, UNM Care, Commercial, Medicare, PHS/Indian Health Service, Salud, Self Pay).
• Front Desk Operations - Answer phones at the 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.
• Referrals - Maintain knowledge of community financial resources and refer patients appropriately.
• Patient Valuables - Accept and issue patient valuables from patients and the Emergency Department staff.
• Floor Visits - Perform floor visits to interview patients after a direct admit from the Emergency Department or the clinics.
• 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.
• Customer Service - Provide information and assistance to internal and external customers; ensure quality service and customer satisfaction.
• Registration - Interview patients and/or families to obtain demographic, financial information, and signatures as required; schedule new and follow-up appointments.
• Data Entry - Enter various data into the computer; verify data, make corrections, and ensure accuracy.
• Customer Relations - Establish and maintain good rapport and effective working relationships with patients, visitors, physicians, and hospital employees.
• Coding - Assign ICD9 or ICD10, CPT codes as required by insurance companies to obtain authorization for services.
• Reports - Obtain police reports when appropriate for billing information for Patient Financial Services; complete Census reports for PBX; work Medicare secondary payor report as assigned.
• Prior Authorization - Complete pre-screening process for specialty clinic appointments for referral and/or prior authorization.
• Liaison - Act as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/coverage and prior authorizations.
• Financial Assistance Referrals - Refer self-pay patients for financial assistance; make financial assistance appointments.
• Outreach/Training - Perform outreach/training with clinical areas to ensure process flow remains efficient and to maintain open communication.
• Data Management - Perform data entry and research using various hospital system programs.
• Related Work - Perform related duties and responsibilities as required.

Qualifications

• Education: High School diploma or GED equivalent.
• Experience: 2 years of directly related experience.
• Nonessential: Bilingual (English/Spanish).

Physical Conditions

Sedentary Work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Working Conditions: Minimal hazard, physical risk, office environment. May be required to travel to various work sites and rotate work shifts.