Patient Registration Outreach Representative I (Remote)

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Rotating - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
The Patient Registration Outreach Representative, under direct supervision of the Patient Registration Outreach Lead, performs specialized functions for SHC patients by completing all activities related to registration, insurance verification, creating estimates and validating authorizations. These activities are performed in accordance with established Stanford Health Care regulations, policies and procedures. The Patient Registration Outreach Representative must have entry level knowledge of healthcare payers, such as Medicare, Medi-Cal, Workers Comp, and all Managed Care plans as well as State and Federal regulations.

What you will do
  • Completes insurance verification and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of service and assigned service line.
  • Understands Real Time Eligibility (RTE) response and update patient account accordingly.
  • Update patient account with correct payer plan type and filling order.
  • Understands coordination of benefits (COB).
  • Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, maximum benefit levels and/or available days.
  • Contacts patient, clinical partners and insurance payers as appropriate to obtain correct and update information when necessary.
  • Completes Medicare Secondary Questionnaire as appropriate.
  • Able to identify Advance Beneficiary Notice (ABN) requirements.
  • Accurately create estimates for upcoming patient services.
  • Collect payments for upcoming services/residual balances to financially secure all applicable accounts.
  • Attention to details and update demographic and insurance information accurately.
  • Must be able to work multiple registration systems.
  • Verify authorization rules and requirements for all payors within the assigned work queues are complete.
  • Develops a strong working knowledge of the procedures and diagnosis used in the assigned service-lines to ensure authorizations are properly completed for the scope of services that will be rendered to the patient.
  • Assesses the data required for authorization and securing sponsorship. Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization.
  • Create Treatment Authorization Requests (TAR) in Medi-Cal website portals.
  • Follows up on pending authorization and referral requests to ensure timely completion and secured sponsorship for cases in the assigned work queue.
  • Arranges escalation process with clinical partners and clinicians to complete peer-to-peer appeal reviews with payor utilization management when needed.
  • Prioritizes work assigned to ensure that financial risk is minimized.
  • Identifies risk associated with coverage and benefit issues related to the services that are being requested for authorization and escalates these issues to appropriate experts to address.
  • Identifies risk associated with securing financial responsibilities prior to service date and escalates to clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, sign PAFR).
  • Collaborates with internal Revenue Cycle Departments to ensure payer authorizations are completed timely.
  • Notifies the department manager with issues, instances of errors, or obstacles to successful completion of work.
  • Applies strong writing skills to account documentation, email communication and internal notes/memos.
  • Manages outbound and inbound phone calls.
  • Responds promptly to customer inquiries.
  • Assists team coordinator and department manager with special projects as needed.
  • Serves as a resource for other payor authorization teams.

Education Qualifications
  • High School Diploma or GED Required

Experience Qualifications
  • 2+ years to 3 years working knowledge of patient registration and insurance verification and authorization processes in a medical organization Required

Required Knowledge, Skills and Abilities
  • Intermediate to advanced knowledge of Microsoft applications (Word, Excel, etc.)
  • Demonstrated communication, customer relations, and organizational skills
  • Ability to multi-task with attention to detail
  • Ability to complete work efficiently and problem solve independently
  • Ability to work well in a team environment

Physical Demands and Work Conditions
Blood Borne Pathogens
  • Category II - Tasks that involve NO exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective:

  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

#LI-RL1

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.