Registration Clerk

Ozarks Healthcare; West Plains (MO); On-site; USD 40,000 - 56,000; Full time

Job summary

Ozarks Healthcare is seeking a detail-oriented compliance and insurance verification specialist to support accurate patient billing and admissions processing. You will review documentation, verify payer requirements, and ensure pre-certification and authorization are in place for admitted patients.

The role focuses on adhering to Medicare, Medicaid, managed care, and commercial payer guidelines, ensuring accurate reimbursement and smooth medical records review.

Qualifications

• Knowledge of Medicare/Medicaid guidelines and payer requirements.
• Attention to detail in insurance verification and reimbursement processes.
• Ability to review and interpret medical documentation for compliance.

Responsibilities

• Complies with Medicare, Medicaid, Managed Care and commercial payer policies for pre-authorization and pre-certification requirements.
• Obtains authorizations and pre-certifications for admitted patients as per insurance plan.
• Verifies insurance eligibility and benefits; reviews and ensures accuracy of patient coverage information.
• Determines primary payer when coordination of benefits is required.
• Serves as a resource on inpatient reimbursement and payer guidelines for the team.
• Works on various projects as requested by supervisor.

Job description

Compliant check on admitted patientsaccounts. Insuring account is accurate

Compliance checks all appropriate diagnosis codes and procedures in the order checker system, ensuring that written documentation with the test ordered, diagnosis and physician order is available for Medical Records staff to review.

Completes Medicare Secondary Payer Questionnaire for all Medicare-eligible patients.

Verifies insurance Eligibility and Benefits

Obtain authorizations and pre-certification for all admitted patients as needed per patient insurance plan.

Obtains pre –admission/pre-certifications/insurance verification to support accurate billing and collections. Fully understands and adheres to the rules and regulations of Medicare, Medicaid, Managed Care and Commercial payers regarding pre-authorization, and pre-certification requirements.

Responsible for reviewing and ensuring accuracy of patient’s insurance coverage information, determining primary payer when coordination of benefits is required.

Must be knowledgeable and adhere to all federal guidelines regarding patient registration and reimbursement. Understands inpatient reimbursement and requirements of guidelines per Medicare, Medicaid, Manage Care, and commercial payers. Serves as a resource for others.

Various projects as requested by supervisor