GENERAL SUMMARY:

Under general supervision and according to established policies and procedures, responsible for providing pre-registrations, registrations, order management, charge capture, cash collection functions and medical information systems. Collecting, analyzing and recording demographic, insurance/financial and clinical data from multiple sources and obtains other information and signatures necessary for the above processes. Screening for third-party eligibility and entering medical necessity coding to ensure accurate payment is secured. Ensuring the needs of patients and their families are met and that they understand the hospital’s revenue cycle expectations, including resolution of personal liabilities through various payment options. Contacting third party payers for verification of benefits and satisfaction of pre-certification requirement for services. Coordinating with physician offices on financial, coding, surgical scheduling processes, coordination of insurance benefits. Ensuring compliance with payer requirements and correctness of registration.

CORPORATE PHILOSOPHY:

It is the obligation of each employee of Edward-Elmhurst Health to abide by and promote the mission and values of the System to ensure that excellent services are delivered with compassion.

PRINCIPAL DUTIES AND RESPONSIBILITIES: (The following duties and responsibilities are all essential job functions, as defined by the ADA, except those that begin with the word "May.")

1. Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served. This includes knowledge of the physical and psychological needs of patients served and the ability to respond appropriately to those needs.

2. Patient Registration:

2.1 Greets and registers patients.

2.2 Collects and analyzes all data required to pre-register and register patients. Interacts with patients, their representatives, employers and others in person, including in treatment and hospital inpatient rooms, or over the telephone, and reviews new and previously recorded information. Reviews and electronically records data and processes transactions into the hospital computer system. Follows HIPAA, EMTALA, payer and other applicable regulations and standards for registration.

2.3 Uses physician ordering systems to retrieve and interpret physician orders for service and/or appointment schedules, enters accommodation and test codes into computer system. Contacts physicians or physician office staff for additional clinical information and clarifying or obtaining orders for inpatient admission and outpatient testing.

2.4 Explains, secures and witnesses all required signatures. Completes the Medicare Secondary Payer (MSP) questionnaire when applicable.

2.5 Updates the billing information in the accounts according to data collected in the questionnaire.

2.6 Scans insurance cards, IDs, insurance referrals and authorizations, consents, physician orders, HIPAA, Medicare Advance Beneficiary Notice, and other regulatory paperwork into hospital’s document imaging system. Prepares required forms, documents, and reports including labels, identification bands, medical record forms, Medicare ABN, payment promissory notes, and other special documents. Produces and distributes these to both internal and external parties.

2.7 Matches registration information with standard EPIC forms. Disseminates information as needed to physician offices or electronic medical record. Assembles and maintains office charts.

2.9 Prepares and maintains reports of various data regarding patient registrations, insurance trends and updates Director in a timely fashion.

2.10 Converts to manual processes and procedures for scheduled and unscheduled computer system downtimes, organizes and maintains all data to ensure a prompt and accurate recovery.

2.11 Performs daily review of revenue and usage reports. Notifies Patient Accounts of errors in daily charging and notifies Revenue Integrity to initiate changes for account correction. Verifies the process has been completed. Works with Revenue Integrity and Director to attach charges to the correct codes.

3. Financial Functions:

3.1 Reviews physician orders and other documentation against insurance payer coverage and medical necessity criteria. Utilizes insurance screening software to determine whether services meet third-party requirements for payment. Explains insurance payer policies to patients. Initiates contact with new patients to review benefits and explain coinsurance responsibility close to the time appointment is scheduled. Obtains missing financial documentation for patients already scheduled to ensure compliance with federal, state and hospital regulations and guidelines.

3.2 Initiates electronic inquiries to insurance payers and claim administrators. Records and electronically enters appropriate data.

3.3 Explains to patients an estimate of the expected charges for the services being provided, the amount expected from the insurance payer, and the amount owed by the patient or responsible party. Negotiates acceptable resolution of expected patient balance. Refers unsuccessful negotiations to the Financial Counselor. Provides information to ensure patients understand the hospital’s billing and credit and collection policies. Discusses self-pay financial responsibility payment options with the patient or responsible party including screening if patient is eligible for financial assistance, pre-approving or denying for charity care, entering data in the computer system, counseling patients on payment of remaining balance due and scanning financial assistance documents.

3.4 Receives cash, check and credit card payments made at time of service as well as balances from prior visits. Post payments, issues receipt to patient/guarantor and maintains record of transactions. Calculates adjustments and/or discounts of total charge amount and posts to account.

3.5 Reconciles daily cash receipts with the day’s cash activity, credit card journal report and computer cash drawer. Prepares daily deposits and forwards to Patient Accounts, maintains cash reserves accordingly and prepares daily cash activity report. Investigates discrepancies in daily cash closing process, corrects errors when possible or notifies supervisor of unresolved balancing issues. Responds to patients’ request for information regarding billing and/or coordinates appropriate replies with financial counselors.

4. Insurance Verification:

4.1 Verifies insurance coverage, obtains pre-certification for required payers and/or services which may include contacts to the physician office and/or insurance company utilizing telephone or online computer system for assigned accounts.

4.2 Obtains and Interprets benefits via online resources when available for payers including but not limited to: Medicare, Medicaid, and any available Managed Care & third party payers.

4.4 Communicates with patients regarding insurance questions and/or scheduling issues that may arise.

4.5 Confirms completeness of accounts to ensure accuracy of data, insurance benefits and that pre-certification requirements have been met.

4.6 Enters all necessary information into EPIC system.

4.7 Accesses various computer programs simultaneously for benefit information and documentation.

4.8 Answers questions regarding pre-certification and benefit coverage.

5. Attends mandatory staff meetings, maintains familiarity with all memos, emails and pertinent information regarding policy and procedure updates retaining them for future reference, understands changes and incorporates them into personal routines. Communicates with Director or Supervisor any problems or questions pertaining to duties and established policies and procedures or, prior to implementation, to any revised protocols.

6. Receives, properly responds to, or redirects telephone, electronic, and in-person inquiries from patients, their representative, payers, physicians and their staff, internal departments, and other persons and entities. Diffuses tense situations, problem solves, keeps situations from escalating, has a calming effect on all external and internal customers. Maintains confidentiality of patient’s personal health information.

7. Assists in the training of new employees.

8. Performs related duties as assigned.

9. Accepts and completes special assignments, projects and other duties as required or assigned under the supervision of the Supervisor or Director.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

• High School Diploma or GED
• Manual dexterity to operate various office machines

Preferred Education and/or Experience:

• Associate Degree in business or healthcare
• Minimum of one year of registration, scheduling, patient accounts, cash collections or customer service experience in a healthcare setting
• Knowledge of health insurances, medical terminology and anatomy
• Strong data entry and keyboarding skills
• Knowledge of Microsoft Office Suite
• Bilingual skills

Location: Edward-Elmhurst Health · OP REHAB SVCS
Schedule: Full time, Days/Evenings, Two evenings