The Registration Specialist is responsible for verifying insurance coverage for outpatient therapy services and obtaining pre-authorization and re-authorization for continued therapy services. Complete daily activity processing that relates to accurate and efficient pre-registration of patient and recording of patient demographic and financial data in the computer system or in the chart. Additional duties will include but are not limited to processing that relates to maintaining current knowledge of eligibility and certification requirements for outpatient therapy services. Maintains open communication and be available to internal and external customers. Communication includes but is not limited to telephone, face to face, and e-mail. Proactively provides excellent internal and external customer service and maintains a working knowledge of industry standards to ensure timely, quality services in accordance with contractual agreements, federal regulations, hospital policies, procedures, and professional standards.
Education
High School Diploma - Preferred
Experience
1 Year Clerical - Required
1 Year Medical/Clinical - Preferred
License & Certification
None Required
Core Job Functions
- Coordinates collection of data to ensure continuous quality improvement throughout operations of department. Manages large amounts of detailed information to ensure the best experience for the patient and timely reimbursement from 3rd party payers. Reports areas of concern to department leadership and makes recommendations for improvement.
- Accurately schedules appointments, enters orders and documentation as necessary. Follows up with missed appointments and reschedules patients. Directs patients to appropriate personnel.
- Demonstrates initiative and flexibility as well as time management. Maintains open communication with co-workers and management. Assists office manager with any duties to facilitate efficient operations of department.
- Assumes responsibility for patient satisfaction related to instructions, wait times, anticipation of needs, and registration process. Promptly answers telephones, voice mails, and emails. Coordinates communication to third party payers and patients to ensure that billing and payments will be efficient.
- Utilizes various websites or phones insurance providers to verify individual coverage for new physical and occupational therapy patients numbering up to 40 cases per day.
- Submits all data necessary to obtain pre-authorization of therapy services or post-treatment authorization. Obtains re-authorization of therapy services for those payors that extend set limits on visits or those that require month-to-month re-authorization.
- Maintains a working knowledge of hospital point of service collections requirements, updates in agreements between SJC and payor sources, and federal regulation regarding therapy caps and information submission.
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