Admitting Representative
4 weeks ago
**Job Summary**:
Under the direct supervision of the Admitting Manager/Supervisor/Designee, the Admitting Representative is a patient service professional responsible for coordinating and completing every phase of the admission function including admissions, pre-admissions, interviews for financial and demographic information, obtains and processes advance directives, obtains patient/agent signatures, may initiate valuables collection and distribution, document preparation for all elective, direct and/or emergency admissions, revenue collection in all settings, and data retrieval. Assures confidential treatment of all communications written and verbal. Will initiate and maintain patient room assignments and status until discharge. Acts as a primary informational resource and provides assistance to both internal and external customers. The Admitting Representative must be capable of making decisions and working independently to achieve all departmental functions, as well as maintain an in-depth understanding of job duties and changes as admitting decisions have significant financial and medical implications.
**Essential Responsibilities**:
REVENUE COLLECTION
Instruct and review with patient, information concerning hospitalization. Ascertain health plan status, research eligibility and collect and copy non-KP insurance information.
Identify all uninsured or under-insured patients admitted to facility; refer to Financial Counselors for further action.
Obtain verification and necessary pending authorizations from non-KP insurers (including Medicare, Medi-Cal and COB) on members and non-members when Financial Counselor is not available. All documentation is completed in the Member Integrated Tracking System (MITS) or the appropriate KP tracking system.
When Financial Counselor is available, discuss the need to obtain authorizations from non-KP insurers (including Medicare, Medi-Cal and COB).
Promote patient satisfaction and retention through the successful facilitation of the revenue collection process.
Calculate member liability based on benefit plan (e.g. Deductible Health Maintenance Organization (DHMO), High Deductible Health Plan (HDHP), Medicare D, Out of Pocket Maximum (OOP Max), etc.); inform patient/agent and collect appropriate cost share payments for services rendered in all settings (e.g. bedside, follow up phone calls to patients home, etc.)
Notify patient and when possible, collect financial liability for elective procedures.
Document all interactions.
Contact all discharged patients to attempt collection of financial liability. Document all interactions.
Research payment records of all non-paying patients with liabilities, utilizing system records. Report findings to Manager/Supervisor/Designee.
Analyze revenue data to determine obstacles in cost share collections. Report daily/weekly to Manager/Supervisor/Designee.
Collect all information necessary to bill second-party payers, e.g. COB, Medicare, Medi-Cal, third-party payers, Workers Compensation, Commercial and Non-KP HMO.
PATIENT INTERVIEW/PREADMISSION AND ADMISSION
Interview patients for pre-admission or admission to the hospital, collecting personal, demographic, financial and medical information in person or by phone per KP policies.
Enter complete data into the KP information systems and review for accuracy per department, local, regional and regulatory compliance.
Affix identification bracelet to the patients wrist on the side of the body opposite the intended procedure or injury per local policy.
Understand and abide by the HIPAA regulations and Kaiser Permanente Corporate Compliance. Provide up-to-date information concerning admission and hospital practices and administrative procedures per HIPAA guidelines. Evaluate and attempt to resolve/refer public and patient concerns as they arise.
Facilitate the timely admission of patients throughout the hospital by coordinating patient information with the physicians, Emergency Room, Clinic Departments, House Nursing Supervisor, Patient Care Unit Staff and Outside Care Coordinators per local policy.
Receives admission requests; facilitates appropriate bed assignments and communicates information to staff.
DOCUMENT AND RECORD MANAGEMENT
Maintain accurate record of cost share status of all patients with liabilities, utilizing revenue tracking system as determined by management.
Obtain appropriate signatures on permits and consents per California Hospital Association (CHA) consent guidelines.
Prepare related admission paperwork in advance to facilitate a timely admission process.
Assemble and coordinate admission materials to create a comprehensive admission package.
Distribute relevant brochures/letters to patient/agent (e.g. Medicare letter, Coordination of Benefits (COB) brochure, advance directive brochure, cost share letter, etc.)
Receive, document, secure and release patient valuables according to Standard Procedure 18A as appropriate.
Initiate membership records o
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