Admitting Representative

Job Title

Under general supervision and guidelines, obtains and verifies financial sponsorship, patient demographics, and clinical information. Utilizes skills and knowledge of department / hospital policies and procedures to register patients, verify insurance benefits, and collect payments. Works in a team environment and must be able to work independently in all areas of registration, including E.R. registration, insurance verification, pre-admission, Out-patient registration, and cashier with minimal supervision.

This position requires the full understanding and active participation in fulfilling the Mission of San Gabriel Valley Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support San Gabriel Valley Medical Center's strategic plan and the goals and direction of the Performance Improvement Plan (PIP).

Responsibilities

• Verifies financial sponsorship, patient demographics, and insurance eligibility during and prior to the registration process.
• Notates all registration activity in the adt/ms4 registration system.
• Quality controls all patient data, checking for accuracy, on all registrations.
• Notifies physician's office, patient of any deductibles, and/or co-pays prior to and after registration.
• Collects and notates (in ADT system) deductibles, co-pays, and cash packages during and prior to registrations.
• Verifies and enters appropriate insurances plan codes, and financial codes.
• Pre-admit and verifies all pertinent patient data, prior to patient arrival when possible.
• Work's where needed, including ER registration, pre-admissions, and registration; must be willing to work flexible hours.
• Interviews patients to compile, verify and update all pertinent information necessary to complete IP, OP and Pre-Admit registrations, birth certificates, claims, billing, or other health information patient access information related
• Assures that patient information is accurately obtained and Informs patients of Federal and State Healthcare Regulations. Explains hospital policies and procedures
• Completes admission forms, prepares identification band and labels. Confirms identification of patient, places band on left or right wrist or other extremity, according to diagnosis.
• Using labels, embosses appropriate admission forms for placement on patient chart. As directed updates face sheet and distributes forms to appropriate departments.
• Secures direct admits verification assignments with the cooperation of the Bed Control RN or Nursing Supervisor for incoming patients.
• Reviews and adheres to the medical staff suspension list and follows hospital protocol when accepting patients. Refers suspended physicians to the appropriate Administrator-On-Call. Displays ability to professionally and assertively handle this sensitive situation.
• Records and places patient valuables in the safe.
• Communicates with the Utilization Review Department regarding possible transfers or problems.
• Knows, uses, maintains, verifies, reconciles, corrects, balances and audits a variety of health information/patient access indexes, lists, reports, accounts, census, logs, computer and optical imaging storage and retrieval systems. Compiles and generates information related to same.
• Obtains patient signature and witnesses all consent forms according to Federal and State regulatory agencies.
• Successfully communicates information to patients regarding the Health Information Privacy and Portability Accessibility Act (HIPAA) and documents accordingly within the CPSI System that patient has acknowledged receipt of their privacy rights and notice.
• Successfully communicates information to patients regarding Advance Care Directives and documents accordingly.
• Has knowledge of third party payers including commercial, HMOs, PPOs, EPOs, Capitation and Worker's Compensation. Demonstrates knowledge of Federal (Medicare) and State (Medi-Cal) payers and basic diagnosis criteria to differentiate Inpatient and Outpatient admissions, and to provide optimum insurance selection for successful reimbursement.
• Verifies managed care requirements and/or insurance information using electronic verification technology as appropriate.
• Obtains authorizations for treatment via telephone, electronic or written documentation as needed by meeting 24 hour notification requirements of carriers.
• Successfully communicates information to patient regarding his/her insurance Benefits.
• Requests, collects and documents appropriate deposits, deductibles and copays from patient or by contracting family or guarantor as needed to secure the account.
• Demonstrates computer literacy, including basic knowledge of hospital computer systems, including PC Windows environment, insurance verification software, optical imaging software, electronic mail, printers, scanners and other office computer hardware.
• Ability to accurately understand, pronounce and spell basic Medical Terminology.
• Assists with the training of new employees when requested.
• Completes cross training in all access areas, including Main Admissions, Emergency Room and Pre-Admission and Insurance Verification.
• Independently completes shared departmental projects in a timely manner (for example, pre-registrations, scanning, etc.)
• Displays sensitivity to the patient's condition in extracting information and assuring maximum confidentiality.
• Answers the phone promptly and provides assistance to all callers in a helpful and efficient manner.
• May perform special assignments and/or other duties as assigned delegated by Lead, Supervisor or Department Director.
• Cashiering duties and ability to collect and post payments to CPSI as well as balance and reconcile daily logs for cash collections.
• Performs other relative duties as assigned or required

Qualifications

EDUCATION/TRAINING/EXPERIENCE

High school graduate or equivalent.

Previous registration, insurance, medical office experience preferred. Knowledge of medical terminology.

Knowledge of computer input and skills

Good communication and guest relation skills.

LICENSES/CERTIFICATIONS

Current MAB Certification

Hospital Description

This position requires the full understanding and active participation in fulfilling the Mission of San Gabriel Valley Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values.