Patient Registration Associate; PRN

Patient Registration Associate (PRN) – Med Star Health

Department: Emergency Room

Status: Per Diem (As Needed)

Schedule: Day/Evening/Night Shifts with rotating weekends (Must be available for all shift types)

General Summary Of Position:

Independently completes pre‑registration and financial clearance activities for Washington Hospital Center patients. The Financial Clearance Representative is responsible for maintaining exemplary levels of customer service in all interactions in accordance with the Washington Hospital Center Mission and Vision. The following major functions describe the essential duties of positions in this job classification. Individual positions may not perform all of these tasks and may perform additional related tasks not listed here.

Assignments will be based upon enterprise needs and at the discretion of the Central Financial Clearance Managers and Director.

Primary Duties And Responsibilities:

• Completes pre‑registration activities, documents results in the registration system for scheduled patients, and contacts patients by phone or in person to obtain and verify demographic and insurance information, communicate outstanding liability, and relay necessary pre‑arrival instructions.
• Uses customer service skills while communicating with the patient, insurance company, employer, or third‑party payor to secure all demographic and financial data necessary for accurate and complete demographic and financial information.
• Contacts insurance carriers or reviews information from insurance verification systems to determine coverage and eligibility, resolves problems and coordinates payor payment responsibility between multiple carriers or sources of coverage (i.e., coordinates benefits between primary, secondary, and tertiary payors), updates patient accounts with appropriate insurance codes, authorizes treatment numbers, calculates number of inpatient days allowed, contacts referring or primary physicians if necessary, and obtains provider numbers according to departmental policies and procedures.
• Reviews and updates demographic/insurance information and accounts status to ensure accounts meet payer requirements/time frames for billing and payment; ensures data quality standards are met through quality monitoring and report reviews.
• Obtains pre‑certification/authorization when required for scheduled services prior to admission or outpatient procedure or upon admission for non‑scheduled services.
• Notifies payors of admission or arrival according to facility contractual obligations.
• Makes final determination whether patients meet hospital financial/insurance eligibility criteria and coordinates activities with physicians, insurance carriers, managed care payors, and other third‑party payers; informs appropriate physician/department/patient when eligibility or authorization criteria are not met and offers alternative options; provides demographic/insurance or other related information to WHC departments (e.g., Social Work, Utilization Review, Physicians, Providers) as needed and according to department procedure.
• Determines, communicates, collects, and documents patient liabilities prior to or at the time of service; establishes contract agreements with patients where applicable per department/hospital policy for outstanding balances.
• Educates patients and family members on insurance coverage and requirements, available resources, and hospital billing processes to ensure that the patient’s financial commitment to the institution is met.
• Accurately obtains ICD‑9/HCPCS and CPT‑4 codes from responsible parties as needed for billing purposes and/or estimating charges for self‑pay patients.
• Knows and adheres to government regulations relative to Medicare Secondary Payor (MSP) screening, Advance Beneficiary Notice (ABN), and Ambulatory Payment Classification (APC).
• Researches denied accounts and recommends whether to appeal or accept the denial; ensures that appropriate denial/appeal codes are entered into the billing system within required time frames.
• Reviews/explains bill(s) to patients and/or third‑party payors; requests corrections for any billing errors.
• Coordinates and addresses financial clearance…