REGISTRATION SPECIALIST LEAD
Loyola University Health System

Job Info

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Employment Type:
Full time
Shift:

Description:
As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.
POSITION PURPOSE

Under the guidance of the manager, this position is expected to perform a higher level of generally more complex job specific responsibilities. Greets patients and family members in a professional and courteous manner. Obtains, and verifies demographic, clinical, financial, and insurance information during the (pre)-registration process, accepts point of service payments or provides guidance for payment options, and clears the patient for service delivery. Acts as the primary point of contact between the Patient Access Concierge Team and management.

Core responsibilities include:

Verifies patient identification, demographic information, and insurance coverage. Accepts point of service payments. Enters patient information accurately into appropriate hospital information system(s). Refers patients with questions regarding financial liability to appropriate resource(s). Accepts medical authorization or referral forms, if appropriate. Processes key documents to facilitate obtaining insurance information. Provides payment estimates for out of pocket costs. Educates patients/families on the use of registration kiosks or online systems. Functions as the point of contact in identifying complex systemic issues and either resolving or escalating to management for resolution. Oversees the training and education of Patient Access Concierge colleagues upon hire and ongoing as new systems and processes are created.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Core Values, and Vision in behaviors, practices, policies and decisions.

Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Leading by example, the team lead protects the safety of patient information by verifying patient identity to preserve the integrity of the patient record and ensures all records are complete, accurate, and unique to one patient.

Performs pre-registration, insurance verification and financial clearance activities in a variety of settings and for multiple patient types. Communicates frequently with patients/family members/guarantors, and physicians or their office staff in the deployment of key activities. Interviews patients to collect data, initiates electronic medical records, validates, and enters data related to procedures, tests, and diagnoses. Determines need for appropriate service authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies the accuracy and completeness of physician orders for tests and procedures, which includes name, date of birth, diagnosis, procedure, date, and physician signature to minimize risk to hospital reimbursement. Accurately uses the patient search feature to find the correct patient information and disseminates data to clinical systems for patient care. Identifies required forms or templates based on the types of services patients will receive.

Performs insurance eligibility/benefit verification, utilizing EDI transactions and payer web access, and calls payers directly. Documents information within the patient accounting system through insurance eligibility/benefit verification. Refers accounts identified as self-pay to benefit advocacy resources. Conducts data search of manuals, physician systems, previous accounts, or payment source history, when appropriate.

Provides financial information and patient payment options. Informs patient/guarantor of liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits, and outstanding balances at the point of pre-registration or point of service. Documents payments/actions in the patient accounting system and provides the patient with a patient estimate of out of pocket costs and a payment receipt in the collection of funds. Acquires necessary documents including patient identification, insurance cards, consent for treatment, assignment of benefits, release of information, waivers, ABNs, advance directives, etc. Identifies need for patient/guarantor signature based on patient encounter/visit. Scans appropriate documents.

Serves as a subject matter expert in providing assistance to patients, family members and visitors in a courteous, professional, and empathetic manner; ensuring timely, efficient customer service in a fast paced, high energy environment. Demonstrates excellent self-directed leadership and communicates with various ancillary departments to ensure smooth patient flow and high data integrity.

Cross trains in various functions to assist in the timely delivery of department services. Performs routine duties relating to patient placement, reservation duties, which includes responsibility for bed assignments, transfers, and providing functional guidance as necessary.

Performs scheduling of patients using HIS or scheduling software as necessary.

Participates on interdepartmental process improvement teams.

Provides subject matter expert knowledge concerning various insurance requirements and billing guidelines. Understands patient access data elements and impacts on insurance claim edits. Knows where information is verified and corrected if needed to produce an edit free claim.

Interprets complex data, draws meaningful conclusions, and presents findings to management for further department advancement.

Provides routine function-specific training, to include development or dissemination of job aids, as part of new staff orientation and continuing education.

Assists the manager in the development and assignment of work schedules.

Performs higher level and generally more complex job-specific responsibilities. May provide specialized technical guidance and support to staff. Under the guidance and direction of the manager, disseminates policy/procedure updates, or other job related information and materials provided by the Manager which support on-going effectiveness of job responsibilities and enhancement of customer expectations.

Takes initiative to continuously learn within assigned job function to support progressive responsibility.

Other lead duties as needed and assigned by the manager.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

PERFORMANCE METRICS

As part of ongoing, on-the-job performance evaluation, colleagues will be expected to achieve pre-determined productivity standards and quality scores through periodic performance reviews. Additional metrics beyond quality and productivity may also be used to determine satisfactory performance and assist in progressing individuals through the position career ladder.

MINIMUM QUALIFICATIONS

High school diploma or an equivalent combination of education and experience. Associate degree in Accounting or Business Administration highly desired. Past work experience of at least four to five (4-5) years within a hospital or clinic environment, an insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities is required. Knowledge of insurance and governmental programs, regulations, and billing processes (Medicare, Medicaid, Social Security Disability, Champus, and Supplemental Security Income Disability), managed care contracts and coordination of benefits is highly desired. Working knowledge of medical terminology, anatomy and physiology, and medical record coding (ICD-10, CPT, HCPCS) is preferred. Must be proficient with the entire Microsoft suite.

Excellent communication skills both verbal and written, data entry skills, and organizational abilities. Superior interpersonal skills are necessary for interacting with customers and colleagues. Accuracy, attention to detail, ability to work independently, and good time management skills are required.

Completion of regulatory/mandatory certifications and skills validation competencies preferred.

Must be a self-starter, comfortable working in a leadership role within a fast paced, results oriented, collaborative, people-centered environment.

Completion of certification and skills competencies such as the Certified Revenue Cycle Specialist Professional (CRCSP) through the American Association of Healthcare Administrative Management (AAHAM) and/or Certified Healthcare Access Associate (CHAA) through the National Association of Healthcare Access Management (NAHAM) is preferred.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in a fast-paced environment that is sometimes stressful with individuals that have diverse personalities and work styles. Excellent problem solving skills are essential.

Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.

Position operates in an office environment. Work area is well-lit and temperature controlled. Job function requires working at a computer. The noise level is low to moderate. Occupational exposure to blood or other potentially infectious materials may reasonably be anticipated in performing duties. Skin, eye, mucous membrane, and/or parenteral contact with blood or potentially infectious material are reasonably anticipated. Must be able to sit or stand for extended periods of time.

Must possess the ability to comply with Trinity Health policies and procedures.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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