Job Description
Job Description
General Summary
Under the general supervision of the Director, Clinical Reimbursement and the direct supervision of the Assistant Director, Patient Administrative Services, evaluates financial status and completes insurance verification and authorization for admissions to the acute care hospital and the psychiatric units in accordance with the UMMS policies and procedures. These admissions include those emergency admits and elective pre-certification for future planned admits.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
Conducts pre-admission registration for elective admissions, including, but not limited to screening patients for appointments based on department guidelines.
Obtains demographic and financial data from patient and accurately inputs data into the Electronic Medical Record (EMR).
Verifies patient’s insurance information and benefits utilizing all verification and eligibility tools and calls payer when needed.
Contacts physician/scheduling office/clinical staff to assist with incomplete patient registration paperwork as well as scanning required documents.
Verifies and/or obtains the necessary pre-certification, authorization, and/or referral prior to services being provided as required by the payer for observation, outpatient and inpatient notifications.
Responsible for collection of patient known costs (copays, deductibles, coinsurance), full cost (non-covered/self-pay) in accordance with department processes as well as referring patients for financial clearance.
Provide hospital estimate of charges as needed.
Responsible for conducting Medicare Lifetime Reserve Day election and securing required signature. Checks MHIN system to ascertain Medicare coverage and the status of primary and secondary coverage as well as the status of the available Medicare days
Communicate and document insurance updates including concurrent review as needed to other departments, such as Perioperative Services, Physician Scheduling Offices, Utilization Management, etc.
Print, reconcile and review previous days’ admissions to ensure payer notification upon observation or admission.
Refers cases to Utilization Management and Director of Perioperative Services for denial and “pending” authorization status review.
Refers uninsured patients to the Medical Assistance Eligibility Team.
Maintains continuous contact with Care Management as necessary to ensure all the necessary information has been obtained for reimbursement, and that admission requirements are followed.
Maintains timely and accurate workqueue processing as assigned.
Communicates effectively with the manager on a day to day basis. Provides information regarding work progress, actions and issues in a timely and effective manner. Gathers and records data used for individual and team performance feedback reporting.
Develops and enhances skills continuously in areas of service quality improvement, customer service and interpersonal skills.
Assist manager with training of new staff demonstrating department operating processes and procedures.
Performs related duties as assigned.
Job Tags
Permanent employment,