Insurance Verification Registrar

POSITON PURPOSE

Under general supervision of the Patient Access Director, the Insurance Verifier/Financial Counselor/Registrarperforms preadmission, registration, and financial counseling for inpatients, outpatients and surgical services patients, verifies insurance coverages and benefits, obtains required authorizations, and assists patients with options for meeting their financial obligations to the hospital. This role is integral in denial prevention.

ESSENTIAL JOB FUNCTIONS

Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position.

• Obtains insurance benefits, proof of coverage and pre-certification/authorization for designated inpatients or outpatients.
• Coordinates with Utilization Review and Patient Financial Services regarding insurance coverage issues.
• Completes registration and scheduling processes according to established protocol, ensuring the integrity of the patient's clinical record. This includes, but is not limited to patient, insurance subscriber, guarantor and physician demographics.
• Meets standards for customer service, registration accuracy, productivity and upfront collection goals. Reviews registrations daily for quality assurance, and correction of errors prior to close of business (reports provided by supervisor).
• Researches scheduled appointment log for 3 days out to ensure appropriate insurance documentation, eligibility and verification, completion of referral and/or authorization requirements, and notification to patient of patient portion due at time of service. Reschedules patient within 24 hours of appointment if insurance pre-certification/authorization requirements are not met.
• Promotes a culture of safety through proper identification, proper reporting, documentation and prevention of medical errors in a non-punitive environment. Arm bands every patient (Red Rules) prior to the end of the registration process.
• Follows the appropriate check in process to electronically date/time stamp patient arrival and departure/handoff times. Includes compliance with EMTALA rules and regulations when working in the Emergency Room, including appropriate registration of the ER OB patient.
• Assists patient in registering for and utilization of the Patient Portal to ensure compliance with Meaningful Use.
• Documents thoroughly and accurately. Flags patient accounts as necessary for collection of past due balances, incorrect demographics, and other critical notifications as needed.
• Utilizes payer websites and/or eligibility interface for eligibility and benefit detail, and assigns insurance plans according to validated results. Performs and documents pre-certification/authorization at time of service for all registrations in compliance with payer requirements. This includes communication to payer of ALL recorded/ordered procedures.
• Discusses Coordination of Benefits with patient. Confirms primary payer and records order of payers correctly within the registration profile. Documents account notes with the results of the COB review. This includes the Medicare Secondary Payer Questionnaire when the primary insurance is traditional Medicare. Assigns insurance plans in the correct order in accordance with MSPQ results.
• Explains registration forms to the expressed understanding of the patient and obtains the signature of the patient or authorized individual in compliance with state and federal guidelines.
• Completes Medical Necessity screening as required by Medicare for outpatient diagnostic services. Communicates the results to the patient on the appropriately completed Advance Beneficiary Notice (ABN) form for services that fail Medical Necessity Screening.
• Calculates patient's share of cost and performs point of service collection in accordance with upfront collection policy and procedure; collecting self-pay portions, co-payments, and past due patient portions at the time of check in; all other collections to be collected at discharge.
• Maintains cash drawer in accordance with established procedures. Participates in the daily reconciliation of cash collected and daily deposit as assigned.
• Abides by the HMH Legal Compliance Code of Conduct.
• Maintains a safe work environment and reports safety concerns appropriately.
• Maintains patient confidentiality and appropriate handling of PHI.
• Performs all other related duties as required and assigned.

LATITUDE, CONTACTS/INTERACTIONS

All positions of Huntsville Memorial Hospital are part of an interdisciplinary team, and as such, participate in the care and service delivery process through effective interaction with other team members. Primarily interacts with hospital staff, medical staff, patients, and visitors.

Requirements

Education: High school diploma or GED required.

Experience: Three years applicable prior hospital experience preferred.

Required Skills: Excellent computer skills, oral and written communication and customer service skills.

PHYSICAL DEMANDS AND WORKING CONDITIONS

Frequent: sitting & reaching.

Occasional: standing, walking, lifting, carrying & pushing.

Visual and hearing acuity required. Work is inside, with good ventilation and comfortable temperature.

Possible exposure to: toxic/caustic chemicals or detergents, communicable diseases, blood borne pathogens.

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off
• Short Term & Long Term Disability
• Training & Development
• Wellness Resources

Qualification

High School or equivalent