Employment Type:

Full time

Shift:

Description:

At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.

We are looking to hire a motivated and dynamic Patient Registration Specialist to support our team in Ontario!

GENERAL SUMMARY AND PURPOSE:

As a Patient Service Representative, you will work in conjunction with physicians and clinical staff to take care of patients’ administrative needs. Your primary responsibilities would include checking in patients for appointments, collecting patient co-pays, answering telephones, taking accurate messages, scheduling appointments, and checking insurance eligibility. Patient Service Representatives utilize our electronic record system to verify and update patient demographic information as well as posting and balancing of payments collected. Patient Service Representatives are friendly and provide excellent customer service, assuring that patients are informed and well cared for while waiting for their appointment, creating a positive experience for patients.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE :

• High school diploma or equivalent required.

• Associate degree in Accounting or Business Administration preferred.

• Prior work experience performing customer service activities within a hospital or clinic environment, an insurance company, managed care organization or other health care financial setting preferred.

• Knowledge of insurance and governmental programs, regulations and billing processes and/or managed care contracts and coordination of benefits preferred.

ESSENTIAL FUNCTIONS :

• Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.

• 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.

• Identifies routine issues and escalates to Supervisor, Patient Access.

• Processes insurance claim forms.

• Reviews claims/accounts for complete information, corrects and completes forms to ensure accuracy.

• Accesses information and translates data into information acceptable to the claims processing system.

• Prepares claims for return to provider/subscriber if additional information is needed.

• Maintains all appropriate claim files and follows up on suspended or outstanding claims.

• Identifies, researches, and resolves issues related to coordination of benefits, subrogation, and general inquiry issues, then communicates the results.

• Identifies routine payer or provider issues and escalates to Lead Patient Financial Services Representative.

• Acts as a point of contact for assigned payers.

• Maintains compliance with HIPAA and other regulatory requirements throughout all activities. 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 Care 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.

• Provides information and 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. 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.

• Interprets data, draws conclusions, and reviews findings with Lead Patient Access Concierge for further review.

• Takes initiative to continuously learn all aspects of Patient Access Concierge role to support progressive responsibility.

• Other 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.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 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.

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

EOE including disability/veteran