Per Diem ED Representative - Manhasset, NY

Position Description:

Healthcare isn’t just changing. It’s growing more complex every day. ICD-10 Coding replaces ICD-9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities. 
 Who are we? Optum360. We’re a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide. If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.
Primary Responsibilities:

Serves as a primary resource in providing information and facilitating services in the Emergency Department.
Greets patients, visitors and employees to the Emergency Department and overall Hospital in a courteous and friendly manner.
Assists medical staff, other hospital departments, physicians, affiliates, patients and their families with requests for information and services.
Provides interpretation of Hospital regulations to patients (i.e. visiting hours, patient services, etc.).
Provides information regarding hospital clinic regulations and services.
Answers telephone calls and takes messages, responding with appropriate department protocol.
Provides hospital rules and regulations, upon request. 
Performs administrative functions to facilitate patient registration.
Interviews patients/significant others and obtains all relevant demographic and insurance data.
Obtains necessary signatures and makes copies of relevant documentation.
Maintains current knowledge of changes in regulations, or policies and procedures, with regard to insurance requirements, hospital policies, etc.
Ensures patients are charged for all services accordingly and initiates corrective action, as needed.  Codes insurance carriers and other system information.
Accurately documents all required information in department log book or computer log. 
Assigns on-line account numbers.  Communicates with Medical Records to see if patient has an existing account number.
Prepares and maintains patient chart packages.
Prepares chart package to include chart, triage note, ED identification card, labels and visitor pass.
Ensures charts are available for medical staff in a timely manner.
Reviews ED census with copies of charts that are collected after services are rendered.
Reviews and ensures charts are accurately documented and completed after services are rendered.
Documents charges and payment data and ensures charts are accurately coded and prepared for billing.
Prepares charts for transfer to Data Processing.  Performs chart break down for billing, filing and/or transfer to Medical Records.
Manages department on-call systems.
Pages and contacts medical personnel, physicians, laboratory, etc.
Assists staff, affiliated physicians and patients/family members acquire needed information, contacts or services.
Initiates Disaster Plan, when necessary.
Utilizes reference lists for referrals when requested.
Submits laboratory test orders, as required.  Receives and documents results.
Processes orders as instructed, ensuring proper labeling of specimens and timely transport to lab.
Notifies medical staff of test results in a timely manner.
Maintains accurate records of orders submitted and follows up with outside departments for results.  Ensures results are documented in patient chart.
Performs related duties, as required.
Verification, Authorization and Compliance:

Follows approved scripting, verifies insurance benefits on all patients registered daily by using electronic verification systems or by contacting payers directly to determine the level of insurance coverage.
Thoroughly and accurately documents insurance verification information in the ADT system, identifying deductibles, copayments, coinsurance, and policy limitations.
Obtains referral, authorization and pre-certification information; documents this information in the ADT system and submits notices of admission when necessary.
Verifies medical necessity check has been completed for outpatient services.  If not completed and only when appropriate, uses technology tool to complete medical necessity check and/or notifies patient that an ABN will need to be signed. Identifies payer requirements for medical necessity.
Verifies patient liabilities with payers, calculates patient’s payment, and requests payment at the time of registration.
Identifies any outstanding balance due from previous visits, notifies patient and requests patient payment.
Sets up payment plans for patients who cannot pay their entire current copayment and/or past balance in one payment.
Thoroughly and accurately documents the conversation with the patient regarding financial liabilities and agreement to pay.
When collecting patient payments, follows department policy and procedure regarding applying payment to the patient’s account and providing a receipt for payment.
Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company.  Ensures this information is clearly documented in the ADT system.
When necessary, escalates accounts to appropriate ED leadership staff, based on outcomes of the verification process and patient’s ability to pay.
Complies with HIPPA, PHI and its implications, ABN, MSP, EMTALA, etc. and other regulations which affect the registration process.
Financial Processing and Assistance:

Understands and follows the “Delay/Defer” procedure and escalates accounts that do not meet financial clearance standards to ED leadership immediately.
Explains the Payment and Billing Assistance Program to all patients regardless of financial concerns or limitations. 
Acts as resource to other hospital departments regarding insurance benefits and requirements and collaborates with other departments, as needed, to ensure proper compliance with third party payer requirements.
Other duties:

Properly handles credit card transactions in accordance with PCI-DSS standards and guidelines.  Will have access to both single card transactions as well as access to data from multiple transactions or reports and files containing bulk transactional information containing un-encrypted or un-redacted credit card information.
If required by facility, inventories and stores patient’s valuables following proper procedure.
Works with physician offices and clinical areas to collect and share patient information and to help update these stakeholders on changes in ED requirements, processes or programs.
The above statements reflect the general details considered necessary to describe the essential functions of the job as identified, and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

Required Qualifications:

High School Diploma or GED 
2+ years of Customer Service experience 
Understanding of Insurance Policies and Procedures
Knowledge of Medical Terminology
Previous experience in EMR
Previous experience in requesting and processing financial payments
Previous experience working with Microsoft Office products
Must be available for Training : 8 weeks on different shifts
Must be able to work every other Sat and Sun 7a-3p
Preferred Qualifications: 

Associates or Bachelor's Degree
Experience in Hospital Patient Registration Department, Physician's office setting, Healthcare Insurance Company, revenue cycle vendor and/or other revenue cycle-related role
Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or _expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.