REGISTRATION & ELIGIBILITY SPECIALIST

Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department and Shift Ambulatory PreRegistration Ctr; 1.00 FTE; Full Time; Shift: Days. Position Summary Perform pre-registration and registration functions for the area assigned; verify insurance coverage eligibility and benefits; obtain authorization for admission; verify required referrals and/or prior authorization are in place; interview patients for outdated or missing demographics; provide professional and efficient phone call handling via telephone ACD system in a call center setting; perform as first contact for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. Advise, inform and assist patients before and after their admission. 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 for patients needing an authorization; notify of admission and obtain authorizations for emergency and scheduled procedures; provide necessary medical documentation; document Cerner accurately; scan documents into Siemens imaging; collect down payments and copays; create pre- admits in Cerner as appropriate. PRIOR AUTHORIZATION – Complete pre‑screening process for specialty clinic appointments for referral and/or prior authorization. FINANCIAL ASSISTANCE (State/Government programs) – Interview patients, complete application process, maintain MOSAA certification, interview and approve patients for UNM Hospital charity and discount programs. FINANCIAL ASSISTANCE (self‑pay) – Refer self‑pay patients for financial assistance; schedule financial assistance appointments. ELIGIBILITY – Determine and process eligibility for financial assistance (Medicaid, SCI, UNM Care, Commercial, Medicare, PHS/Indian Health Service, Salud, Self Pay). REFERRALS – Maintain knowledge of community financial resources and refer patients appropriately (EMSA). TRAINING (registration personnel) – Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices, including financial assistance programs. TRAINING (clinical areas) – Perform outreach/training with clinical areas to ensure tight process flow and maintain open communication. CUSTOMER RELATIONS – Establish and maintain rapport with patients, visitors, physicians and hospital employees. DEVELOPMENT – Enhance professional growth through educational programs, literature, in‑services, meetings and workshops. LIAISON – Liaise between clinic staff, providers, insurance companies, and other payors to coordinate financial benefits/coverage and prior authorizations. FRONT DESK – Answer phones, assist walk‑in patients, provide after‑hours information desk coverage, re‑identify patients for Blood Bank and Health Information, organize folders for floor visits, admit surgical and direct admissions, input pre‑admits for PALS, log all admissions. PATIENT CARE (direct admits) – Accept and issue patient valuables; perform floor visits to interview patients after direct admittance from Emergency Department or clinics. CASH – Reconcile and complete cash reconciliation reports; balance and post payments, contractual allowances, and denials. REPORTS – Obtain police reports when appropriate for billing; produce Census reports for PBX; prepare Medicare secondary payer reports as assigned. RELATED WORK – Perform related duties and responsibilities as required. SIGNATURE – Obtain proper signatures for Medicare Rights Consent for Treatment, financial assistance forms, and other appropriate documents; ensure patient rights are distributed. INFORMATION – Interview patients/families at admission, pre‑admission or discharge; update demographic and financial information; register patients for laboratory and after‑hour clinics; provide billing info to ambulance services. CODING – Assign ICD-9/ICD-10, CPT codes as required by insurance companies to obtain authorization. DOCUMENTATION – Send pertinent medical documentation to insurance companies and other payors; document final authorization in Cerner; scan all paperwork into Siemens scanning. Qualifications Education High School or GED equivalent. Experience 2 years directly related experience. Nonessential: Bilingual in English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo. Credentials Not applicable / Not required. Physical Conditions Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently. Seating most time; may involve walking or standing briefly. Working Conditions No or minimal physical hazard in office environment. May be required to travel to various work sites. May be required or required to rotate work shifts. #J-18808-Ljbffr