Registration & eligibility specialist

Department: BHO - Admitting/Registration - UPC FTE: 1.00 Full TimeShift: 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and benefits; verify required referrals and/or prior authorization are in place prior to visit; contact patients for outdated or missing demographics; professional and efficient phone call handling via telephone ACD system in a call center setting; perform as first contact for Persons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 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