Job Title: Inpatient Registrar & Reimbursement Specialist Job Code: 880050
Immediate Supervisor: Director of Payer Relations Status: Non-exempt
DEPARTMENT FUNCTION/JOB OVERVIEW
Responsible for the efficient and orderly registration of inpatient admissions for Madonna business lines. Obtains and completes patient demographic information, consents and authorizations and ensures patients are aware of financial responsibility. Other responsibilities include maintaining daily operations of billing process, maintaining referral inquiries, typing, word processing, faxing, photocopying for the department. Responsible for quality service delivery and internal/external customer relations for the department and Madonna as a whole, including upholding the mission and values for the department and facility. Ability to prioritize, organize and effectively handle multiple tasks and interruptions in a positive manner.
Responsible to know, understand and apply the facilityâ??s reimbursement process from the IP registration process through collection. Proficient in the use of the Registration Application of AFFINITY. Responsible for collecting, verifying, recording, revising and overseeing financial payer information for all inpatient programs. Consults, advises, and assists the IP Registrar Supervisor & Director of Payer Relations in providing leadership and direction in planning and coordinating customer access.
- Verifies primary and secondary payers and clarifies benefits per policy for inpatients to ensure proper billing.
- Notifies the pre-admission case manager/nurse liaison of payer benefits and requirements for pre-authorization/pre-certification to maximize reimbursement.
- Computes and records the Medicare benefit days used and available for all Medicare Part A recipients for accurate Medicare billing.
- Verifies Medicaid eligibility for all inpatient programs.
- Maintains and revises AFFINITY components of the Admissions Protocol Manual to ensure proper orientation and education of staff.
- Develops, analyzes, plans, implements, and follows up on quality improvement processes to increase productivity and efficiency of department operations and resource management.
- Reviews, files, and maintains daily registration reports.
- Reviews the â??Interrupted Stayâ? report and documents appropriate data on the â??hospital Interrupted Stayâ? worksheet to assure that staff has accurate information required to achieve accurate reimbursement. Reviews and maintains the â??MDS Activityâ? worksheet and makes necessary room accommodation changes in the system to ensure appropriate charges are submitted for billing.
- Identify admissions that are related to a motor vehicle accident and maintain a log and monitor that the Accident Questionnaire is completed and forwarded to patient accounts.
- Adds employers to Employer Dictionary.
- Checks Missing Insurance Information Report.
- Responsible for acquiring all Accident Report Forms. Understands and operationalizes admission policy and procedures.
- Obtains and enters required demographic information into the computer system prior to the patientâ??s admission. Verifies accuracy and generates an admission record in a timely fashion.
- Investigates and communicates third party liability coverage to appropriate staff.
- Analyzes, computes and records the Medicare benefit days available upon admission for all Medicare Part A recipients for accurate Medicare billing.
- Maintains physician master maintenance file.
- Reviews registration reports and follows up on any missing items from the admission process and makes necessary corrections.
- Monitors daily admissions, transfers, and discharges and appropriately records transactions in the computer system.
- Enters daily activity on the Intranet and calls appropriate staff with changes in the activity.
- Coordinates the receipt of the â??ID Screenâ? for Medicare patients in the Subacute/SNF program.
- Copies, distributes the pre-admission assessment form to the appropriate areas.
- Copies and distributes, files, and mails the MIMR screens to the appropriate internal and external personnel.
- Updates patient demographic and financial information to ensure complete and accurate files.
- Maintain month end report for admit/non-admit referrals.
- Follow up on all accident/injury related incidents in obtaining the correct documentation (i.e. accident reports).
- Enter all required information upon notification of an in house transfer.
- Upon notification of new Long Term Care Unit admit, pertinent demographic information is obtained and entered into the system.
- Data entry of any updates to demographic information in relationship to the LTC unit.
- Pre-Admit Main Case, ECN Lab Case, OP Case, Pharmacy Case for all LTC admissions/transfers.
- Post LTC admission, receives copies of the admission documents and updates information in the system.
- Collaborates and communicates with others effectively and professionally to insure successful and efficient outcomes both internally and externally.
- Interviews and registers incoming patients and/or family of the patient in person or via telephone prior to admission.
- Describes facility payment policies and expectations, explains insurance coverage and responsible party obligations, communicates insurance non-coverage to the patient, obtains and witnesses necessary signatures on facilities forms.
- Escorts patients and families to their assigned rooms. Patients arriving by ambulance are escorted to their rooms by ambulance personnel.
- Maintain patient confidentiality. Follows facility protocols in communicating and releasing patient information.
- Answers the telephone quickly and courteously as needed.
- Receives, greets and directs patients and visitors in a positive and conscientious manner.
- Orders supplies and forms; contact vendors as needed to ensure proper equipment functioning/maintenance.
- Communicates and collaborates with staff of other departments to coordinate the registration and reimbursement process, on joint projects, and to meet necessary deadlines in order to enhance departmental and facility proficiency.
- Takes instruction from supervisor to perform other functions as assigned in order to achieve the goals within the department as well as within the facility.
- Communicates with various insurance companies, attorneys, hospitals, other extended care facilities, and governmental agencies to obtain and/or verify necessary demographic, financial and liability information.
- Maintain and ensure a safe environment for the department. Handles and operates all necessary equipment and performs required duties according to established safety standards to maintain compliance with regulations and prevent injury.
- Must be able to operate admissions/patient software, copier, telephone, fax machine and have basic computer skills, including e-mail, word processing to type, complete patient data, letters and memos.
- Creates patient armbands to be applied at the time of admission.
- Types individual UR, Denial letters for external customers.
PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS
Light work - walk/stand constantly while stooping, pulling/ pushing cabinets, reaching/climbing to retrieve material, twisting at desk to reach, type, answer phone and occasional lifting of approximately 20 pounds, pushing patients in wheelchair to the appropriate patient room. Manual dexterity and acuity for computer entry. Clear speaking voice and average hearing for phone communications.
Inside office setting with noise from numerous telephones, keyboards, printers and simultaneous conversations.
QUALIFICATIONS (Education/training and/or Experience)
High school equivalency with one year post high school education and two years relevant work experience required. Experience is to consist of any of the following: medical registration, insurance processing/collection, awareness of Medicare, Medicaid, and insurance benefit information. Demonstrated ability within a related position at Madonna may be considered in lieu of two years relevant experience. Additional relevant work experience would be considered in lieu of formal education. Must have working knowledge of personal computers and Microsoft office programs such as (Word, Access, Outlook, Excel, etc.), and office machines. Must have excellent communication and organizational skills with the ability to problem solve. Must be able to work in demanding situations without adverse reaction and interact in a positive manner with staff and public, either in person or via telephone.