What are the responsibilities and job description for the Ambulatory Patient Registration Specialist position at Southwell, Inc.?
DEPARTMENT: Internal Medicine SMC Ambulatory PHY
F ACILITY: Affinity West Campus
WORK TYPE: Full Time
S HIFT: Daytime
SUMMARY:
The Ambulatory Patient Registration Specialist serves as the first point of contact for patients entering the facility or scheduling appointments. This role is responsible for reviewing insurance eligibility, obtaining precertification or prior authorization when required, discussing good faith estimates, collecting patient responsibility amounts, and completing system-wide patient registration.
RESPONSIBILITIES:
- Obtains and verifies patient demographics, guarantor details, and insurance information for new or established patients by telephone or in person in accordance with departmental policy.
- Answers telephones and transfers calls to the appropriate personnel and departments.
- Analyzes insurance information or encounters to determine pre-certification and prior-authorization requirements.
- Contacts insurance carriers to obtain pre-certification and prior-authorization numbers and contacts patients or provider offices as needed to verify or obtain required data.
- Ensures the patient record is updated with accurate information and that the insurance record reflects all appropriate insurance coverage in the correct order of priority (coordination of benefits).
- Ensures all registrations are completed prior to the scheduled appointment.
- Analyzes all deductibles and co-payments to be collected in accordance with insurance benefits for outpatient services.
- Assists with additional projects as needed and as assigned by department leadership.
- Promotes excellent customer service to both internal and external customers.
- Provides cost estimates for outpatient services in accordance with the Good Faith Estimate Act.
- Maintains productivity standards as outlined by leadership.
- Adheres to Point of Service (POS) collections standards as outlined by leadership.
- Scans valid forms of identification, insurance cards, and prior authorizations into the system.
- Informs patients of the Consent for Treatment, Patient Bill of Rights, Joint Privacy Practice, and other required admission forms at the point of service.
- Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. (“TRHS”) policies as they presently exist and as they change or are modified.
- Understands and adheres to: TRHS’ compliance standards as they appear in TRHS’s Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
- Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
- Offers suggestions on ways to improve operations of department and reduce costs
- Attends all mandatory education programs.
- Improves self-knowledge through voluntarily attending continuing education/certification classes.
- Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety, and health requirements as well as service excellence education hours requirements.
- Cross trains to better assist co-workers and to provide maximum efficiency in the department.
- Volunteers/participate in hospital committees, functions, and department projects.
- Manages resources effectively.
- Reports equipment in need of repair to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
- Makes effective use of time to not create needless overtime.
- Takes personal responsibility for the quality and timeliness of work and achieves results with little oversight.
- Review monthly avoidable denials and offers support to APAR for implementing improvements.
- Displays an ongoing commitment to learning and self-improvement and acquires new knowledge or skills for work
EDUCATION:
- High School Diploma or Equivalent
OTHER INFORMATION:
- Insurance experience preferred
- Customer Skills preferred
Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.