Registration & Eligibility Specialist

• Perform pre-registration and registration functions for Ambulatory/Outpatient Operations area assigned
• verify insurance coverage eligibility and benefits
• verify required referrals and/or prior authorization are in place prior to visit
• contact patients for outdated or missing demographics
• 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
• perform intake applications for State of NM Medicaid
• Ensure adherence to Hospitals and departmental policies and procedures
• Assist patients in locating departments
• schedule and coordinate patient appointments
• refer patients and families to appropriate services and resources
• Provide information and assistance to internal and external customers
• provide and ensure quality service and customer satisfaction
• Perform data entry and research using various hospital system programs
• Enter various data into computer
• verify data, make corrections and ensure accuracy
• Interview patients and/or families to obtain demographic, financial information and signatures as required
• schedule new and follow-up appointments
• Verify insurance coverage and benefits on patients needing an Auth
• provide notification of admission and obtain auth for emergency admits
• obtain authorizations for same day surgery, inpatient surgery, direct admits and any other pre scheduled stays or procedures
• Provide all pertinent medical history/documentation for insurance companies and other payors in order to obtian an auth
• document Cerner with correct information
• Scan all documents concerning authorization and reimbursement into Siemens document imaging
• may collect down payments for and copays for procedures
• Create Pre Admits in Cerner as appropriate
• Complete pre-screening process for specialty clinic appointments for referral and/or prior auth
• Interview patients and complete the application process for State/Government programs
• maintain MOSAA certification with the State
• interview and approve patients for UNM Hospital charity and discount programs
• Refer self-pay patients for financial assistance
• make financial assistance appointments
• Determine and process eligibility for financial assistance (Including Medicaid, SCI, UNM Care, Commercial, Medicare, PHS/Indian Health Service, Salud, Self Pay)
• Maintain a knowledge of community financial resources and refer patients appropriately (EMSA)
• Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices to include financial assistance programs
• Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication
• Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospitals employees
• Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
• Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/ coverage and prior authorizations
• Assign ICD9 or ICD10, CPT codes as required by insurance companies in order to obtain authorization for services
• Send all pertinent medical documentation to insurance companies and other payors for approval
• Document final authorization in Cerner and scan all paperwork into Siemens scanning
• Answer phones at front desk and assist walk-in patients as needed
• Provide after hours/weekend information desk coverage for the hospital
• Re-identify patients for Blood Bank and Health Information Management Department
• Organize folders for floor visits to patients
• Admit surgical patients and direct admits that present to the Admitting office
• Input all pre-admits for PALS and direct admissions as appropriate
• Log all admissions in the Admitting logs
• Accept and issue patient's valuables from patients and the Emergency Department Staff
• Perform floor visits to interview patients after a direct admit from the Emergency Department or the clinics
• Reconcile and complete cash reconciliation reports
• balance and post payments, contractual allowances, and denials
• Obtain police reports when appropriate for billing information for Patient Financial Services
• Do the Census reports for PBX
• Work Medicare secondary payor report as assigned
• Perform related duties and responsibilities as required
• Obtain proper signatures for Medicare Rights Consent for Treatment, financial forms for applying for assistance, and other forms as appropriate
• assure that patient rights are distributed
• Interview patients and/or family at time of admission, pre-admission or discharge to obtain accurate demographic, and financial information
• update information on Hospitals computer system to ensure correct billing
• register patients for the Laboratory and clinics after hours
• provide billing information to Ambulance Services

• High School or GED Equivalent
• 2 years directly related experience
• Bilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo
• Not Applicable/Not Required

Bilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo

• Full health/dental/vision with no deductible for full-time employees
• Retirement with up to 6% match
• PTO and 9 paid holidays
• Amazing shift differentials including up to 26% for weekend nights
• Sign-on bonuses and relocation assistance