Job Facility: University of Maryland Medical Center
Employment Type: Full Time
What You Will Do:
Under the general supervision 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.
Accepts reservations for future admissions from physicians’ offices and physician teams. Receives this information via the hard copy “white card: or via the IDX system.
Resolves incomplete information for the planned admits by contacting the physician’s office for the required additional insurance or medical information that is requested by the third party payers.
Conducts pre-admission review of elective admissions in conjunction with Clinical Denial staff for medical appropriateness of inpatient versus outpatient procedure. Contacts the physician office for clarification of the status based upon the planned procedure and the decision of the third party payer.
Documents the process components and the information obtained is detailed in the HBOC STAR system for review by PFS in the processing of the claim and the sending of a bill. Completion of the insurance screens in the STAR modules is also part of their expectations for documentation.
Provides ongoing assistance to the AdmissionsTestingCenter in preparation of the initial medical chart paperwork and patient plates for those cases scheduled emergently by the physician staff.
Completes insurance verification process once the patient has been admitted for inpatient elective procedure or same day surgery procedure.
Completes the information verification obtained by Bed Management staff regarding the insurance coverage for all emergency patients admitted within the past 24 hrs and rechecks the information originally gathered on the planned admissions.
Interviews patients to acquire demographics for insurance verification and/or confirms present status when necessary for both the planned elective procedure cases as well as those emergently admitted to this facility.
Contacts pre-certification areas and benefits of the various third party payers to obtain authorization for the admission to this facility for their member. Verifies that the information is accurate for the episode of care. Informs patients of financial liability, collects co-payments and refers payment arrangements to patient Financial Services.
Refers uninsured patients to the Medical Assistance Eligibility Team.
Checks Medicare aged persons against the MHIN system to ascertain the presence of Medicare coverage and the status of the primary or secondary coverage as well as the status of the available Medicare days
Documents the process components and confirms that the information obtained adheres to departmental and medical center specific standards for the patient selection and the data entry. The information is documented in the HBOC STAR system for review by the PFS in the processing of the claim and the sending of a bill. Completion of the insurance screens in the STAR modules is part of the expectation for documentation by this group.
Communicates the necessary information regarding the need for concurrent review by specific third party payers to the Case Management staff via e-mail as per departmental standards. Notification of onsite nurse reviews of the members admitted via departmental procedure.
Refers cases to the clinical reimbursement specialists for their review and possible intervention. These include one-day admissions, weekend admissions and problem cases identified by the third party payers.
Communicates effectively with the immediate supervisor on day to day issues. 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. Communicates with Case Management staff and physician office staff on an ongoing basis to continually improve the certification process.
Develops and enhances skills continuously in areas of service quality improvement, customer service and interpersonal skills. Participates in UMMS educational opportunities. Attends in-service training programs as required.
Assists supervisor with training of staff on an ongoing basis with new information from third party payers. Offers information to the supervisor to share with Bed Management of continuous quality improvement.
What You Need to Be Successful:
High School Diploma or equivalent is required (GED)
Two years work experience in a clerical position in a healthcare setting such as an acute care hospital, physician’s office or HMO, performing admissions processing or patient registration work.
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.