- Interview all patients, or referring physicians to obtain all financial and demographic information required for reimbursement for services rendered.
- Enters patient registration data into appropriate systems according to established procedures to ensure proper reimbursement from third party payers and patients.
- Verifies third-party insurance coverage for prospective patients and verifies day of service eligibility for appropriate insurance.
- Directs patients with financial concerns and directs them to staff who can assist them in the completion of necessary forms and applications for financial assistance from private and/or public funding.
- Collects deposits for co-payments, and completes reconciliation process per proper procedures.
- Verifies and updates demographics, insurance and provider information on existing and new patients.
- Assigns medical record numbers to new patients in order to ensure current information in the Master Patient Index (MPI) upon completion of a registration.
- Creates and/or updates occasion of service for all patients.
- Verifies the Rehab Benefit and the type of coverage and if prior approval for service is necessary for payment of services rendered.
Management of Authorization/Referral:
- Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers patients and any other parties to ensure that required managed care referrals and prior authorizations are obtained and appropriately recorded for patient appointments/visits prior to scheduled patient visits or retro-actively if not in place at the time of the appointment/visit. Ensure that approval numbers are appropriately linked to the relevant patient appointment/visit.
- Verifies insurance through eligibility or payer systems
- Routinely produce the appropriate missing referral reports to identify scheduled visits for which a referral is required but is not yet documented.
- When it is determined that a valid referral does not exist, utilize computer-based tools or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system.
- Contact internal and external primary care physicians to obtain referral/authorization numbers.
- Perform follow-up activities indicated by relevant management reports.
- Review practice management reports and resolve any registration or insurance information in order to complete the managed care referral/authorization.
- Contact patients when information required to obtain referrals or authorizations is not complete. Serve as a liaison between practices and patients to communicate the status of obtaining referrals and authorizations.
- Communicate with patients regarding their responsibility for contacting insurance carriers in order to update inaccurate information. Follow-up as necessary to ensure that updates have been completed.
- When an appeal is necessary, write timely appeal letters and send to patients and insurance carriers in accordance with carrier guidelines as required.
- Work collaboratively with the practice to resolve registration and insurance verification issues, to the extent that these unresolved issues impact the ability to obtain a referral.
- Contact patients and providers, to prospectively obtain managed care approvals. Notify appropriate staff of all patients without required approvals for determination of whether patient will be seen. Note in appropriate system, any decisions about the status of unapproved patients.
- Mail out managed care referral or authorization letters in accordance with department policies.
- Regularly undergo audits to achieve the required standard.
- Answers telephone promptly and provides Access support to all.
- Acts as an expert and liaison to facilitate Rehab Therapy appointments.
- Utilizes expertise and knowledge to schedule all procedures based on diagnosis, therapeutic sub specialty, and urgency.
- Handles all last minute calls for emergent and add on patients, and is able to appropriately assign priority.
- Ability to cope with high-pressure situations and demonstrate independent thinking and decision making as well as a high level of diplomacy.
- Deals discreetly with sensitive information, maintaining confidentiality at all times.
- Obtains and enters patient information and procedure data into hospital computer systems (EWS, E-REFERAL, SDK, EPIC)
- Reviews the following day Rehab Therapy schedule to finalize the schedule and to ensure data accuracy.
- At 24 hours before scheduled appointment, re-verifies the type of coverage and ensure that appropriate prior approval has been completed.
- Maintains records and files, as needed. Prepares reports relative to daily schedules, as needed.
- Uses computer to schedule appointments necessary for follow up appointments as appropriate.
- Uses EWS and Outlook Calendar to monitor the schedules of therapists avoiding conflicts and assuring that all commitments are properly noted on the therapist’s schedules.
- Performs cross-booking appointment scheduling interpreters.
- Reschedules patients from cancelled or bumped appointments procedures.
- 24-48 hours prior to visit of NEW patient – performs confirmation call.
- Attends scheduled training sessions for systems upgrades or newly acquired clinical systems, registration updates, available resources for verifying insurance, and all trainings as required.
- Facilitates transfer of referrals and all medical documented paper work to designated areas.
- Faxes patient records to other providers and insurance notification to insurers.
- Maintains an adequate inventory of office supplies and order as needed.
- Performs manual clinic scheduling and registration functions using accepted downtime procedures.
- Contacts the Help Desk at the BMC computer department to report faulty systems or hardware.
- Notifies area supervisor/manager of problem(s) to ensure that it is addressed in a timely manner.
- Covers/”floats” to other areas under the direction of a manager and/or supervisor.
- Maintains proper dress code.
- Organizes work area for efficiency, neatness and safety.
- Communicates with all members of staff on work related issues effectively and courteously.
- Assures that all messages for therapists and designees are accurate and forwarded promptly to the therapist and/or designee.
- Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided.
- Utilizes hospital’s Values as the basis for decision-making and to facilitate the hospital mission.
- Follows established hospital infection control and safety procedures.