Patient Registration / Prior Authorization Clerk (FT)

Description

With a range of services - from emergency care to diagnostic imaging, rehabilitation and surgery - we serve people of all ages in Edgerton, Milton, Janesville and the surrounding communities. Edgerton Hospital has been the center of the community's health care since 1920, and we continue to grow and evolve in response to changing medical needs.

Our Mission

Improving Health & Wellness for Longer, Healthier Lives

Our Vision

We will serve our communities with exceptional quality, innovative health services and wellness promotion.

Our Values

I CARE

Integrity. Compassion. Accountability. Respect. Excellence.

Join an organization that truly values your overall health and well-being & provides excellent work / life balance! If you are hardworking, dependable, & team-oriented - we'd love to hear from you!

Our Patient Registration / Prior Authorization Clerk reports to the Patient Registration Director and supports Edgerton Hospital by performing a wide variety of medical office clerical functions including prior authorization, insurance verification, and registration duties. Responsible for obtaining complete and accurate insurance information and prior authorization for outpatient services. Performs clerical duties including (but not limited to) : insurance verification, prior authorizations, coordinating requests for release of information, and review and / or audit of patient records for completion. The position requires the ability to make decisions consistent with clinic / hospital policies and the confidentiality of patient information.

Additional duties :

Obtaining complete and accurate information from all patients receiving health care at Edgerton Hospital and Health Services for billing and identification purposes.

Will work effectively & efficiently with all departments involved in the financial aspect of the patient's stay.

Safeguards the public image of the hospital by consistent professional conduct.

Interview incoming patients or representatives and enter patient demographic and insurance data into the EPIC system.

Identify primary and secondary payer and plan types.

Identify and meet third party plan requirements such as preauthorization.

If Medicare, determine if it is traditional or managed care Medicare.

If Medicare, determine if Medicare is secondary payer.

Determine and collect copayment and / or deductible.

Identify patients who may need financial counseling based on their ability to pay and refer to Patient Support or Social Services.

Obtain signed statements from patient to protect the hospital's interests.

Coordinate financial agreements with patients based on the Revenue Cycle Policy and Procedures.

Consistently responds to requests from patients for account charge settlement and related information in a timely and courteous manner.

Keep accurate EMR's on all patients, under scope of responsibility; provide appropriate field documentation to include accurate assignment of payer class as needed.

Responsible for being familiar with regulatory changes issued by intermediaries and insurance companies to determine how changes could impact claims processing.

Demonstrates an understanding and knowledge of billing policies and procedures in performing job duties and instructing patients and hospital personnel.

Receive payments and accurately record any monies received.

Responsible for accuracy of cash drawer and deposits.

Perform general clerical functions; answer telephones, type, compiles necessary reports and maintains filing systems for information needed to complete work within the department.

Provides quality control feedback as it relates to the quality, accuracy and timeliness of other departments as it is related to the admissions process.

Answer switchboard as determined by shift worked.

Direct patients, visitors and vendors to area requested.

Utilizes the HIS to its full capacity by CRT. Continues to grow as a user of the EMR system as its capabilities expand.

Requirements

Experience of one year in working either in a position requiring basic interviewing skills, counseling or customer service preferred