Insurance Verifier - FT - Days

Clerical, Administrative &Registration Edinburg, Texas


Description

Position at DHR Health

 

POSITION SUMMARY:

The Registration Representative performs general registration functions including appointment scheduling, collection of applicable co-pays, co-insurance, and deductibles and utilizing the computer system.  Obtains complete and accurate patient demographic, insurance, financial information and patient benefits/eligibility; referral/pre-authorizations/pre-certifications approvals from insurance companies and physician offices. 

 

­POSITION EDUCATION/QUALIFICATIONS:

  • High School Diploma/GED is required.
  • Excellent customer service skills.
  • Computer skills required with knowledge of Microsoft Office suite.
  • Good written and verbal communication skills required.
  • Bilingual – English/Spanish.

 

JOB KNOWLEDGE/EXPERIENCE­:

  • Must be able to respond to patient needs by interpreting facial expressions and to communicate effectively utilizing verbal and written communications.
  • One (1) year of related customer service experience
  • Requires reasoning ability and good independent judgment.
  • Requires working with frequent interruptions and have strong customer service skills.
  • Must have good working knowledge of computers.
  • Knowledge of medical terminology and the ability to communicate in both Spanish and English is strongly preferred.  

POSITION RESPONSIBILITIES:

  • Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
  • Demonstrates high quality Service Excellence, positive customer service and telephone etiquette by treating all customers with dignity and respect; utilizing age specific skills and knowledge.
  • Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
  • Interviews patient or responsible party to obtain demographic information required to register the patient accurately.
  • Obtains and reviews doctor’s orders for appropriate signature, date, diagnosis and admission status prior to registration.
  • Communicates effectively with doctor’s office to obtain orders when missing or when additional diagnosis is needed for medical necessity.
  • Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name and group number.
  • Ability to identify the appropriate coordination of benefits for insurance carrier.
  • Utilizes on-line verification systems, i.e. TMHP, FISS, and Availity, etc., for eligibility.
  • Explains rates, estimates charges for services and hospital policy regarding up-front collections as needed.
  • Opens and closes cash batches appropriately and uses the approved naming guidelines.
  • Collects deductibles, co-pays, unpaid balances and co-insurance payments and provides patient a receipt.
  • Determines financial status and refers patient for financial screening as appropriate.
  • Adheres to Administration on-call schedule, if Financial Counselor is off duty.
  • Performs appointment scheduling functions and registers patients for ancillary services.
  • Initiates Order Management to enter orders as needed.
  • Reviews records of any prior patient visits to determine status of any unpaid balances.
  • Ability to take over the counter payments from patient statements.
  • Ensures referral/pre-authorization/pre-certification requirements have been met.
  • Accurately completes the Medicare Secondary Payer (MSP) form as appropriate.
  • Initiates Pathway Compliance Advisor to determine if an ABN will need to be provided to patient for services identified as not medically necessary.
  • Provides patient the Important Message from Medicare for all Medicare inpatient admissions.
  • Ensures patients are provided Conditions of Admission form and signature is obtained.
  • Scans photo ID, insurance cards, doctor’s order in the appropriate document type in RegAssist.
  • Utilizes Form Fast to print or reprint forms and labels.
  • Verifies and places appropriate wrist bracelet on patient with the two required patient identifiers.
  • Accurately reconciles cash drawer, creates deposit and adheres to security measures.
  • Completes the necessary reports and patient logs, on a daily basis.
  • Ability to assemble patient charts in the proper order for next day schedule.
  • Effectively communicates information about scheduled case procedures to various departments and personnel.
  • Consistently adheres to Doctors Hospital at Renaissance dress policy.
  • Other duties as assigned.

LINES OF REPSONSIBILITES:

Director… Assistant Director…Manager … Supervisor…Lead Registration Representative