Job Summary: Registers patients to receive medical services in clinic, hospital inpatient, Ambulatory, or Emergency services. Obtains demographic information, validates and verifies insurance, and receives payments, based on established manual or technological protocols, refers patients to Financial Advocates. Answers and/or refers questions received from patients, visitors, staff as appropriate. Performs various related cash handling procedures per SOX control regulations. Staff members in this position may perform all, or a combination of the duties described depending upon their assigned work area and the specific needs of the department.
Essential Responsibilities:
Registration: Greets and registers patients for various medical care in the clinic setting potentially in a 24 hour, 7 day a week environment and in a highly active fast paced setting such as the Emergency department. Verifies the patient demographic and insurance information with the patient consistent with the National Registration Standards and regional policies. Verifies Insurance Eligibility and Benefits (including policy limitations) for all payers using approved system to check for eligibility and benefit information. Uses problem-solving skills to verify patient identification through patient name, spouse names, social security number, date of birth and address in order to identify and minimize duplicate medical records. Interview patient to obtain/determine payer source, financial and demographic information and obtains appropriate signatures. Verifies, identifies, and inputs Other Coverage Information (OCI), primary, secondary, and tertiary payers for services provided.
Revenue Collection: Determines and collects cost-shares, and partial payments for services to be received. Enter/verify payments in the computer, close cash drawers, count currency, checks, and credit card payments at the end of each shift, and create deposits per cash handling policies. Maintains billing accuracy and compliance per KPNW and National Revenue Cycle policies. Communicate to the patient the Northwests policy on payment of services or prepayment when significant patient liabilities are identified. Collect past due balances and refers, as appropriate, to financial counselors.
Appointing & Messaging: Takes messages as required according to scripts and guidelines. May schedule and/or cancel appointments based on members needs and regional policies and procedures. If applicable, makes return appointments and referrals.
Regulatory/Organizational Compliance: Explains and requests patients to sign regulatory forms such as consent and release forms as required. Makes copies or scans of patient identification, insurance information and other related forms and documents. Fully understands and adheres to the rules and regulations of Medicare, Medicaid, Managed Care and Commercial payers regarding referrals, preauthorization and pre-certification requirements. Is knowledgeable and maintains compliance with CMS by accurately completing Medicare Secondary Payer screening information. Explains basic KPNW Medical Center and/or clinic policies and procedures to patients.
General Services: Stocks appropriate forms and supplies. Demonstrates responsibility in handling supplies and equipment in a cost-effective manner and according to standards such as policies, procedures, and infection control guidelines. Assist patients by providing phone numbers, facility directions and office layouts; Directing to other departments and administrative services for further information, for example (but not limited to) Membership Services, Dental and Pharmacy. May assist with the orientation of new personnel. Performs all other duties as assigned consistent with job description.