Perform pre-registration and registration functions for area assigned; verify insurance coverage eligibility and benefits; obtain authorization for admission; verify required referrals and/or prior authorization are in place; interview patients for outdated or missing demographics; professional and efficient phone call handling via telephone ACD system in a call center setting; perform as first contact for Persons in Custody of Law Enforcement Agency (PICLEA) as they arrive for care; screen patients for coverage and assist them in navigating their financial options including UNMH or other UNM Health Systems financial assistance, NM Medicaid, or other State and Federal Programs. Advise, inform and assist patients before and after their admission. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.
PATIENT CARE - Assist patients in locating departments; schedule and coordinate patient appointments; refer patients and families to appropriate services and resources
CUSTOMER SERVICE - Provide information and assistance to internal and external customers; provide and ensure quality service and customer satisfaction
DATA - Perform data entry and research using various hospital system programs
DATA ENTRY - Enter various data into computer; verify data, make corrections and ensure accuracy
REGISTRATION - Interview patients and/or families to obtain demographic, financial information and signatures as required; schedule new and follow-up appointments
PRIOR AUTH/INSURANCE - Verify insurance coverage and benefits on patients needing an Auth; provide notification of admission and obtain auth for emergency admits; obtain authorizations for same day surgery, inpatient surgery, direct admits and any other pre scheduled stays or procedures. Provide all pertinent medical history/documentation for insurance companies and other payors in order to obtian an auth; document Cerner with correct information; Scan all documents concerning authorization and reimbursement into Siemens document imaging; may collect down payments for and copays for procedures. Create Pre Admits in Cerner as appropriate
PRIOR AUTHORIZATION - Complete pre-screening process for specialty clinic appointments for referral and/or prior auth
FINANCIAL ASSISTANCE - Interview patients and complete the application process for State/Government programs; maintain MOSAA certification with the State; interview and approve patients for UNM Hospital charity and discount programs
FINANCIAL ASSISTANCE - Refer self-pay patients for financial assistance; make financial assistance appointments
ELIGIBILITY - Determine and process eligibility for financial assistance (Including Medicaid, SCI, UNM Care, Commercial, Medicare, PHS/Indian Health Service, Salud, Self Pay)
REFERRALS - Maintain a knowledge of community financial resources and refer patients appropriately (EMSA).
TRAINING - Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices to include financial assistance programs
TRAINING - Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication
CUSTOMER/STAFF RELATIONS - Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospital employees
DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
LIAISON - Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/ coverage and prior authorizations
CODING - Assign ICD9 or ICD10, CPT codes as required by insurance companies in order to obtain authorization for services
DOCUMENTATION- Send all pertinent medical documentation to insurance companies and other payors for approval. Document final authorization in Cerner and scan all paperwork into Siemens scanning
FRONT DESK - Answer phones at front desk and assist walk-in patients as needed. Provide after hours/weekend information desk coverage for the hospital. Re-identify patients for Blood Bank and Health Information Management Department. Organize folders for floor visits to patients. Admit surgical patients and direct admits that present to the Admitting office. Input all pre-admits for PALS and direct admissions as appropriate. Log all admissions in the Admitting logs.
PATIENT CARE - Accept and issue patient's valuables from patients and the Emergency Department Staff. Perform floor visits to interview patients after a direct admit from the Emergency Department or the clinics
CASH - Reconcile and complete cash reconciliation reports; balance and post payments, contractual allowances, and denials
REPORTS - Obtain police reports when appropriate for billing information for Patient Financial Services. Do the Census reports for PBX. Work Medicare secondary payor report as assigned
RELATED WORK - Perform related duties and responsibilities as required
SIGNATURE - Obtain proper signatures for Medicare Rights Consent for Treatment, financial forms for applying for assistance, and other forms as appropriate; assure that patient rights are distributed
INFORMATION - Interview patients and/or family at time of admission, pre-admission or discharge to obtain accurate demographic, and financial information; update information on Hospitals computer system to ensure correct billing; register patients for the Laboratory and clinics after hours; provide billing information to Ambulatory Services
High School Diploma or GED equivalent
2 years directly related experience
Experience Requirements - Preferred:
Bilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo
Physical Demands Requirements:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Addendum - Tuberculosis testing is completed upon hire and additionally as required
Addendum - N-95 FIT test
Working Conditions Requirements:
No or min hazard, physical risk, office environment
May be required or is required to rotate work shifts
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.