General Summary

Under the general supervision of the Director, Clinical Reimbursement and the direct supervision of the Assistant Director, Patient Administrative Services, evaluates financial status and completes insurance verification and authorization for admissions to the acute care hospital and the psychiatric units in accordance with the UMMS policies and procedures. These admissions include those emergency admits and elective pre-certification for future planned admits.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Conducts pre-admission registration for elective admissions, including, but not limited to screening patients for appointments based on department guidelines.
• Obtains demographic and financial data from patient and accurately inputs data into the Electronic Medical Record (EMR).
• Verifies patient’s insurance information and benefits utilizing all verification and eligibility tools and calls payer when needed. 
• Contacts physician/scheduling office/clinical staff to assist with incomplete patient registration paperwork as well as scanning required documents.
• Verifies and/or obtains the necessary pre-certification, authorization, and/or referral prior to services being provided as required by the payer for observation, outpatient and inpatient notifications.
• Responsible for collection of patient known costs (copays, deductibles, coinsurance), full cost (non-covered/self-pay) in accordance with department processes as well as referring patients for financial clearance. 
• Provide hospital estimate of charges as needed.
• Responsible for conducting Medicare Lifetime Reserve Day election and securing required signature. Checks MHIN system to ascertain Medicare coverage and the status of primary and secondary coverage as well as the status of the available Medicare days
• Communicate and document insurance updates including concurrent review as needed to other departments, such as Perioperative Services, Physician Scheduling Offices, Utilization Management, etc.
• Print, reconcile and review previous days’ admissions to ensure payer notification upon observation or admission.
• Refers cases to Utilization Management and Director of Perioperative Services for denial and “pending” authorization status review.
• Refers uninsured patients to the Medical Assistance Eligibility Team.
• Maintains continuous contact with Care Management as necessary to ensure all the necessary information has been obtained for reimbursement, and that admission requirements are followed.
• Maintains timely and accurate workqueue processing as assigned.
• Communicates effectively with the manager on a day to day basis. Provides information regarding work progress, actions and issues in a timely and effective manner. Gathers and records data used for individual and team performance feedback reporting.
• Develops and enhances skills continuously in areas of service quality improvement, customer service and interpersonal skills.
• Assist manager with training of new staff demonstrating department operating processes and procedures.
• Performs related duties as assigned.

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

Education and Experience

• Completion of a high school level education with attainment of a high school diploma or a State High School Equivalency Certificate (GED) is required.
• Minimum 2 years related work experience is required.
• Working towards or obtained Certified Healthcare Access Associates (CHAA) certification preferred
• Minimum of two years’ work experience in a clerical or receptionist position in a health care setting such as an acute hospital, physician’s office, or a Health Maintenance Organization, performing admissions processing or patient registration work is preferred
• Demonstrated knowledge of the operation of Epic for on line patient registration system for entry and retrieval of demographic and financial information, retrieval of patient information and departmental performance statistics is required
• Knowledge of health insurance principles and practices is required.
• Current knowledge of payer requirements for referrals and authorizations is preferred

Knowledge, Skills and Abilities

• Knowledge of data entry and use of a computer for patient registration and demographic information, retrieval of patient information and review of financial information. 
• Knowledge of routine office equipment such as a fax and copier.
• Demonstration of proficiency word processing for data entry in account notes in the financial system.
• Familiarity with the operation of personal computers.
• Effective written and verbal skills are required to relate to multiple levels of clinical and administrative personnel. 
• Ability to observes and applies relevant hospital and departmental policies and procedures. And demonstrate and promote positive guest relations.
• Ability to work with minimal supervision and to respond appropriately under stress.

All your information will be kept confidential according to EEO guidelines.