OUTPATIENT VERIFICATION REPRESENTATIVE
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POST DATE 9/1/2016
END DATE 10/25/2016
Yale New Haven Health
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values integrity, patient-centered, respect, accountability, and compassion must guide what we do, as individuals and professionals, every day.
Responsible for reviewing patient accounts before and after visits to ensure that patients comply with all third party policies and managed care requirements in order to guarantee payment to the hospital. Verifies eligibility and benefits, obtaining authorizations and approvals, and takes all steps necessary to protect the patient and the Hospital from unnecessary financial loss. Also performs various other access functions, such as: appointment scheduling, registration and account resolution functions. Ensures positive interactions with patients, family members, medical staff, third party representatives and hospital personnel. Promotes good customer service in the work environment. Effectively utilizes all computer systems to ensure that the responsibilities of the Registration Department are met. Performs certain statistical and QA functions. Develops new procedures and participates in the planning and implementation of system improvements to enhance the operating functions of the department.
* 1. Insurance and Billing Requirements - Demonstrates a solid understanding of city, state, federal and third party payors policies and requirements to determine appropriate methods for payment and possible eligibility for agency assistance.
* 2. Managed Care Functions - Provides information to the third parties to determine benefits and obtains the necessary approvals and authorizations to ensure that all managed care accounts can be billed and timely payment received.
* 3. Account Responsibility - Demonstrates the ability to function independently while exercising good judgment and exhibits a favorable attitude to serve the best interest of the hospital/health system. Identitfies deductibles and co-insurance and other self pay balances as well as debt accounts and notifies the patient and initiates other referrals and/or applications when applicable as a representative of the Hospital by establishing and maintaining open communication verbal or written with Hospital personnel, third party payors, employers, various agencies and medical personnel to provide for the both physical and financial well-being of patients, while protecting the financial position of the Hospital.
* 4. Problem Solving - Demonstrates a thorough understanding of all the functions that relate to scheduling, registration and verification as well as a global understanding of the hospital as a whole. Integrates a variety of resourses and avenues to assess the needs of the staff. Uses good problem solving methods and resourcefulness to resolve issues.
* 5. Customer Service - Works with staff to create a patient/family, physician and employee experience that exemplifies caring, understanding, efficiency and overall quality of service. Demonstrates the ability to balance customer service with the financial needs of the hospital. Acts as a role model in providing exceptional customer service.
* 6. Computer Systems - Maintains knowledge of current computer systems, for example those used in registration, scheduling, accounts receivable, patient care, patient tracking and Web based on-line eligibility systems.
* 7. Registration Functions - Exhibits a thorough understanding of various insurance carrier options and verifies eligibility as outlined in departmental procedures. Gathers patient demographic, billing and financial information in a timely and accurate manner. Identifies self-pay balances and initiates other funding referrals and/or applicaitons when applicable.
High School graduate with demonstrated continuing education at a college level program or equivalent experience. Bachelor's Degree preferred.
Three or more years experience in a hospital Scheduling or Registration Department with emphasis on scheduling, registration and/or patient tracking functions.
Excellent interpersonal skills. Has the ability to effectively communicate with all disciplines and all levels of customers both written and verbal. Strong working knowledge of PC's and related software to prepare a variety of reports. Must be able to work under constant pressure and use strong organizational skills. Must have knowledge of Medical Insurance requirements, eligibility, billing & reimbursement. Demonstrates working knowledge of Medical Terminology.