Registration & Eligibility Specialist

Compensation Disclaimer

Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations.

Department: ASAP BHO - Admitting/Registration

FTE: 1.00
Full Time

Shift: Days

Position Summary:

Perform pre-registration and registration functions for Ambulatory/Outpatient Operations area assigned; verify insurance coverage eligibility and benefits; verify required referrals and/or prior authorization are in place prior to visit; contact patients for outdated or missing demographics; professional and efficient phone call handling via telephone ACD system in a call center setting; perform as first contact for Persons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; perform intake applications for State of NM Medicaid;
Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.

Detailed responsibilities:

* 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 RELATIONS - Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospitals employees

* DEVELOPMENT - Enhance professional growth and development through…