Pre-Arrival Specialist (Breast Health Services), part time, days

CURRENT HOLLAND HOSPITAL EMPLOYEES- Please apply through Find Jobs from your Workday employee account.
Responsible for pre-arrival verification, scheduling and registration of patients. Demonstrates a good knowledge of medical terminology and diagnostic modalities to produce quality work responsive to patient and provider needs while optimizing convenience and proper staffing for the clinical departments. Performs clinical order entry. Gathers demographic and payer information through interview with patient or their representative following appropriate departmental and hospital procedures. Assures pre-authorization is obtained. Verifies patient benefits and financial responsibility.
Job Type: Part Time, 48 hours every two weeks
Shift Length: Tues,Thrs, Fri (varied start between 7:25a-8a ending 4p-4:30p)
Weekend Frequency: No Weekends/Holidays
Education Requirements:
-High school diploma/GED, or higher education
Demographic and Financial Registration

• Verifies patient identification per hospital policy.
• Scans ID and Insurance Cards into hospital system.
• Interviews patients for visits to various ancillary departments to obtain complete and accurate demographic and financial data.
• Verifies and updates demographic information for every visit regardless of how often the patient presents for services.
• Accesses various software systems to determine correct payer and benefit information.
• Demonstrates ability to interpret information and enter it into the Health Information System.
• Demonstrates knowledge of how to respond if no payer information is available for the patient or if patient is self-pay.
• Demonstrates understanding regarding identifying and entering the correct guarantor in situations including minors, client guarantors, and legal guardians.
• Explains and obtains compliant signatures on registration forms
• Answers patient and family way finding questions or directs them appropriately.
• Escorts patients if needed.
• Acts as a preceptor as needed.

Compliance

• Understands importance to complete processes as educated to maintain compliance in all areas of Patient Access
• Presents and obtains signatures on necessary forms including but not limited to Treatment Consent Payment Agreement, Notice of Privacy Practice, Patient Belongings, Important Message from Medicare, and Advanced Beneficiary Notice.
• Obtains all applicable demographic registration information related to Meaningful Use, including but not limited to race, ethnicity, birth/administrative sex, and patient portal information.
• Obtains all applicable financial registration information including Medicare Secondary Payer (MSP) questionnaires to ensure compliant ranking of payers.

Insurance Verification and Authorization

• Verifies payer and authorization accuracy prior to, on or after the patient's date of service.
• Uses critical thinking to assure the hospital gets proper reimbursement for outpatient procedures,
• Inpatient/Observation patient stays, and surgical services.
• Uses customer service and communication skills when speaking with patient or provider regarding the need for pre-authorization prior to date of service.
• Coordinates with internal departments, provider's offices, and patients when a service does not meet authorization or medical necessity requirements resulting in the patient to accept financial responsibility for services.
• Stays up-to-date on payer authorization requirements.

Clinical Procedure Appointment Scheduling

• Schedules appointments for clinical testing/procedure requested by physicians, nursing units, or patients.
• Demonstrates skill in coordinating various schedules ensuring: 1) tests are scheduled for patient needs and convenience; 2) scheduling decisions take into account physician, staff and equipment availability; and, 3) patients are scheduled within the time slots directed by department leadership.
• Uses critical thinking to ensure that a valid order is received.
• Demonstrates ability to determine where to send the order and/or scan it into the administrative system.
• Enters payer information during the scheduling process. Understands what to do if pre-authorization is required.
• Able to explain to physician office staff why a procedure cannot be scheduled without proper pre-authorization.
• Verifies correct order is tied to the appointment.
• Updates as needed based on protocol notes and requirements.
• Verifies medical necessity when applicable.
• Demonstrates ability to explain medical necessity to the provider's office and/or patient.
• Communicates with other departments to ensure good patient flow.

Actively looks for ways to gain efficiencies, opportunities to enhance compliance, improve processes, and share education. Actively participates in department meetings. Appropriately suggests topics for discussion. Brings areas of concern or suggestions to the attention of management.
Holland Hospital is an Equal Opportunity Employer, please see our EEO policy