Summary

Job Summary: Interviews incoming patient or representative and enters information required for admission to the computer. Performs related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1.  Advises patient/guarantor of financial obligations; collects and processes deposits, co-payments and pre-payments for services. Assists patients in resolving issues with billing and collection of their hospital account(s). Reviews and analyzes patient account information, payment history, verification and collection of insurance or other coverage information and/or assists patients in submitting needed information to billing or setting up payment arrangements.

2.  Contacts and consults with a patient, guarantor, or other representative, as well as with various County, State, Federal or other outside agencies regarding patient matters related to eligibility for health care services. Interprets laws and regulations of Federal, State and County programs and advises patient of eligibility requirements, as well as their rights and obligations in receiving financial services from these programs. Assists patients in completing applications and forms when necessary and reviews for accuracy and completion. Informs and advises medical providers of patients’ financial status and maintains open communication with Physicians and clinical staff to ensure timely notification of any health conditions or diagnosis that could qualify patient for programs to assist them with their healthcare costs.

3.  Determines eligibility for a third party payment source according to established policies and procedures including private health plans, Victims of Crimes, Workers’- Compensation and lawsuit settlements.

4.  Enters patient admitting information into computer and routes printed copy to designated department. Obtains signed statement from patient to protect hospital's - interests. Maintains confidentiality in maintaining all patient records.

5.  Escorts patient or arranges for escort to assigned room or ward. Stores patient's valuables. Receives payments on accounts.

6.  Immediately updates all patient financial information in the hospital/clinic information system and enrolls all applications and supporting documentation to the appropriate agencies and/or departments within prescribed timelines, to ensure timely and accurate submission of claims needed to maximize reimbursement to the Medical Center.

7.  Interviews patient or representative to obtain and record name, address, age, religion, persons to notify in case of emergency, attending Physician, and individual or insurance company responsible for payment of bill. Explains hospital regulations such as visiting hours, payment of accounts, and schedule of charges.

8.  Plans, organizes and prioritizes workload and processes information at a speed necessary for successful job performance. Assists with special projects and performs- related clerical and administrative duties as required.

9.  Provides training to other staff for the purposes of registration and eligibility. Registers and interviews patients to obtain demographic and financial information necessary for patient identification, billing and collection of accounts.

10. Reviews and investigates health care coverage and policy limitations to update patient information for long term care, short term treatment and/or programs such as Charity, County Medical Services Program (CMSP), Medi-Cal, Family P.A.C.T., Child Health and Disability Program (CHDP), ADAP, and all other related programs.

11. Reviews difficult or unusual cases with Supervisor or Lead Worker for clarification and to ensure accuracy in assessing patient financial circumstances and eligibility determinations. Stays informed of both internal and external programs. Researches, reviews, interprets, and follows all relevant policies, procedures, regulations, guidelines and laws and attends mandatory trainings. Works independently with minimal supervision.
 

Qualifications:

Education: High school diploma or general education degree (GED).

Education: Successful completion of the Eligibility Academy/Training Programs and the respective examination offered through AHS.

Minimum Experience: Bilingual, where necessary.

Minimum Experience: Demonstrated use of PC and related applications. Minimum Experience: Six to twelve months in a customer service field.