Education and Experience-

Education:

• High School diploma, or equivalent.

Experience:

• (1) Year of experience in a hospital or healthcare facility preferred.

Duties and Responsibilities-

Essential Duties:

• Performs pre-registration and financial clearance for multiple patient types (inpatient admissions, outpatient observation, diagnostic outpatients, and ambulatory (day) surgery.
• Completes insurance verification, eligibility and benefit determination process utilizing an integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of the patient financial clearance department. Interprets and documents the appropriate co-pay, deductible share of cost, co-insurance, maximum benefit levels, and/or available days. 
• Completes Medicare Secondary Questionnaire as appropriate.
• Pre-registers the patient for upcoming visit(s), including validating/obtaining and entering demographic, clinical, financial, and insurance information into the patient accounting system.
• Develops a strong working knowledge of the procedures and diagnoses used in the assigned service lines to ensure referrals or authorizations are properly completed for the scope of services that will be rendered to the patient.
• Communicate with respective clinics and referring providers to secure appropriate information to complete a referral or authorization.
• Prioritizes work assigned to ensure that financial risk is minimized, and timely completion of authorization is optimized.
• Identifies risk associated with securing financial clearance before the service date and escalates to the clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel).
• Understands the role of financial counseling in securing clearance for cases that do not have authorization secured timely.  Properly refer these cases as appropriate to management.
• Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurance, deductibles, deposits, and outstanding balances at the point of pre-registration. Calculates patient liabilities and provides financial education, referring the patient to resource counseling as required. Documents payments/actions in the patient accounting system.
• Provide information regarding directions, parking, transportation service, overnight accommodation, etc. during pre-registration calls.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Contact scheduling and/or ancillary department staff for clarification of diagnosis and/or test/procedures.
• Ensures that referrals are addressed promptly.
• Assemble information concerning the patient’s clinical background and referral needs.
• Contact and review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information, such as history, diagnosis, and prognosis.
• Notifies the department manager of issues, instances of errors, or obstacles to successful completion of work.
• Manages outbound and inbound calls.
• Respond promptly to customer inquiries.
• May assist other departmental personnel as needed. Cross-trains in various functions as needed to assist in the smooth delivery of departmental services.
• Other duties as assigned.

Coquille Valley Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Coquille Valley Hospital complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Coquille Valley Hospital expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Coquille Valley Hospital’s employees to perform their job duties may result in discipline up to and including discharge.