Department: Finance Registration
Shift: 8:00 a.m. - 4:00 p.m

JOB SUMMARY

Under the direction of the System Manager of Patient Access, Pre-Processing, collects information to preregister patients, verifies insurance and/or other payment sources for all outpatient-related services, including same day procedures and other ambulatory and hospital-based outpatient services. Identifies and determines order of priority for coordination of benefits (COB). Responds to customer concerns and reports status to Supervisor or Manager.

The pre-registration specialist's role helps to avoid implications of incomplete preregistration/insufficient staffing. Such implications include, but are not limited to, inability to locate the patient file in the system and/or submit a request for pre-certification, non-submission of claims for processing, and payment discounts and/or timely filing denials.

Typical Duties

• Utilizes electronic reports and/or schedules to identify patients needing to be preregistered for admission and same day surgery, in addition to any outpatient and/or ancillary services
• Contacts patients via telephone to preregister at least 5-7 days prior to schedule appointments
• Completes initial screening of self-pay patients to determine eligibility for financial assistance of hospital-based outpatient services
• Acquires all essential demographic and insurance information needed for processing and pre-registration purposes
• Identifies procedures that require pre-certification and subsequently notifies the appropriate department.
• Utilizes eligibility vendor, or other electronic communication media to verify benefits
• Identifies and determines order of priority for coordination of benefits (COB)
• Updates Patient Management System with all insurance coverage updates; classifies the patient account with the appropriate coverage
• Makes appropriate notes documenting the reason patient information may be missing from the file
• Responds to customer concerns in a timely and professional manner and reports all developments or outcomes to System Manager of Patient Access, Pre-Processing
• Answers all incoming phone calls in an efficient and courteous manner
• Adhere to HIPAA standards and complies with patient confidentiality policies for the retention of patient information, handling, distribution or disposal of patient health information
• Adheres to key performance indicators (KPI's) to meet departmental and organizational pre-registration goals
• Communicates with supervisors, managers, and patients daily; physicians, administrative and clinical staff members occasionally
• Performs other duties as assigned by the department System Manager of Patient Access, Pre-Processing