About this role
Overview
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
12. Using labels, embosses appropriate admission forms for placement on patient chart. As directed updates face sheet and distributes forms to appropriate departments.
13. Secures direct admits verification assignments with the cooperation of the Bed Control RN or Nursing Supervisor for incoming patients.
14. 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.
15. Records and places patient valuables in the safe.
16. Communicates with the Utilization Review Department regarding possible transfers or problems.
17. 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.
18. Obtains patient signature and witnesses all consent forms according to Federal and State regulatory agencies.
19. 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.
20. Successfully communicates information to patients regarding Advance Care Directives and documents accordingly.
21. 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.
22. Verifies managed care requirements and/or insurance information using electronic verification technology as appropriate.
23. Obtains authorizations for treatment via telephone, electronic or written documentation as needed by meeting 24 hour notification requirements of carriers.
24. Successfully communicates information to patient regarding his/her insurance Benefits.
25. Requests, collects and documents appropriate deposits, deductibles and copays from patient or by contracting family or guarantor as needed to secure the account.
26. 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.
27. Ability to accurately understand, pronounce and spell basic Medical Terminology.
28. Assists with the training of new employees when requested.
29. Completes cross training in all access areas, including Main Admissions, Emergency Room and Pre-Admission and Insurance Verification.
30. Independently completes shared departmental projects in a timely manner (for example, pre-registrations, scanning, etc.)
31. Displays sensitivity to the patient's condition in extracting information and assuring maximum confidentiality.
32. Answers the phone promptly and provides assistance to all callers in a helpful and efficient manner.
33. May perform special assignments and/or other duties as assigned delegated by Lead, Supervisor or Department Director.
34. Cashiering duties and ability to collect and post payments to CPSI as well as balance and reconcile daily logs for cash collections.
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.
Other facts
About AHMC Healthcare
6-Hospital Health Care System.
Located in the Greater San Gabriel Valley area, AHMC consists of 6 comprehensive acute care facilities.•1,023 total beds
•Over 6,500 employees
•Over 2,500 physicians
•Over 76,000 patients seek care through our ERs
•Over 200,000 total patients treated annually
AHMC is committed to providing the highest quality, most compassionate care for our community.
What you'll do
- The Admitting Representative is responsible for verifying patient demographics, financial sponsorship, and insurance eligibility while ensuring accurate data entry in the registration system. They also collect payments and communicate necessary information to patients regarding their insurance benefits and hospital policies.
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