General Summary Under general supervision, performs pre-admission processing and authorization processing for admissions to the acute care hospital for the University of Maryland Medical System. Ensures the accurate registration of patients and obtains authorizations to ensure financial stability.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
Conducts pre-admission registration for elective admissions, including, but not limited to screening patients for appointments based on department guidelines.
Obtains demographic and financial data from patient and accurately inputs data into the Electronic Medical Record (EMR).
Verifies patient's insurance information and benefits utilizing all verification and eligibility tools and calls payer when needed.
Contacts physician/scheduling office/clinical staff to assist with incomplete patient registration paperwork as well as scanning required documents.
Verifies and/or obtains the necessary pre-certification, authorization, and/or referral prior to services being provided as required by the payer for observation, outpatient and inpatient notifications.
Responsible for collection of patient known costs (copays, deductibles, coinsurance), full cost (non-covered/self-pay) in accordance with department processes as well as referring patients for financial clearance.
Provide hospital estimate of charges as needed.
Responsible for conducting Medicare Lifetime Reserve Day election and securing required signature. Checks MHIN system to ascertain Medicare coverage and the status of primary and secondary coverage as well as the status of the available Medicare days
Communicate and document insurance updates including concurrent review as needed to other departments, such as Perioperative Services, Physician Scheduling Offices, Utilization Management, etc.
Print, reconcile and review previous days' admissions to ensure payer notification upon observation or admission.
Refers cases to Utilization Management and Director of Perioperative Services for denial and "pending" authorization status review.
Refers uninsured patients to the Medical Assistance Eligibility Team.
Maintains continuous contact with Care Management as necessary to ensure all the necessary information has been obtained for reimbursement, and that admission requirements are followed.
Maintains timely and accurate workqueue processing as assigned.
Communicates effectively with the manager on a day to day basis. Provides information regarding work progress, actions and issues in a timely and effective manner. Gathers and records data used for individual and team performance feedback reporting.
Develops and enhances skills continuously in areas of service quality improvement, customer service and interpersonal skills.
Assist manager with training of new staff demonstrating department operating processes and procedures.
Performs related duties as assigned.
THE MEDICAL HEART OF MARYLAND
Treating over 330,000 patients every year, the University of Maryland Medical Center is at the vital core of Maryland's health care system and community. We're known for our prestigious expertise in innovative research and education, along with the talented staff and advanced centers that make it all possible. The R Adams Cowley Shock Trauma Center, the world's first center dedicated to trauma, treats more than 7,500 critically injured patients a year with an incredible 97 percent survival rate. We also have one of the nation's largest kidney and pancreas transplant programs at The Joseph and Corinne Schwartz Division of Transplantation, home to Maryland's first steroid-free protocol and pancreas/kidney transplant. From our National Cancer Institute-designated UM Marlene and Stewart Greenebaum Cancer Center to The University of Maryland's Children's Hospital, one of the largest pediatric centers in the state, we are dedicated to saving and transforming lives.
Education and Experience
Completion of a high school level education with attainment of a high school diploma or a State High School Equivalency Certificate (GED) is required.
Working towards or obtained Certified Healthcare Access Associates (CHAA) certification preferred
Minimum of two years' work experience in a clerical or receptionist position in a health care setting such as an acute hospital, physician's office, or a Health Maintenance Organization, performing admissions processing or patient registration work is required
Demonstrated knowledge of the operation of Epic for on line patient registration system for entry and retrieval of demographic and financial information, retrieval of patient information and departmental performance statistics is required
Knowledge of health insurance principles and practices is required.
Current knowledge of payer requirements for referrals and authorizations is preferred
Knowledge, Skills and Abilities
Knowledge of data entry and use of a computer for patient registration and demographic information, retrieval of patient information and review of financial information.
Knowledge of routine office equipment such as a fax and copier.
Demonstration of proficiency word processing for data entry in account notes in the financial system.
Familiarity with the operation of personal computers.
Effective written and verbal skills are required to relate to multiple levels of clinical and administrative personnel.
Ability to observes and applies relevant hospital and departmental policies and procedures. And demonstrate and promote positive guest relations.
Ability to work with minimal supervision and to respond appropriately under stress.
All your information will be kept confidential according to EEO guidelines.
The University of Maryland Medical System (UMMS) was created in 1984 when the state-owned University Hospital became a private, nonprofit organization. It has evolved into a multi-hospital system with academic, community and specialty service missions reaching every part of the state and beyond. UMMS is a national and regional referral center for trauma, cancer care, neurocare, cardiac care, women's and children's health and physical rehabilitation. It also has one of the world's largest kidney transplant programs, as well as scores of other programs that improve the physical and mental health of thousands of people daily. The hospitals and health systems that comprise UMMS are: University of Maryland Medical Center, University of Maryland Medical Center Midtown Campus, UM Rehabilitation and Orthopaedic Institute, UM Baltimore Washington Medical Center, UM Capital Region Health, UM Charles Regional Medical Center, UM St. Joseph Medical Center, UM Upper Chesapeake Health, UM Shore Regional Health, Mt. Washington Pediatric Hospital and UM Community Medical Group.