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SalaryGENERAL PURPOSE:
This position works in the Main Admitting, Emergency Room and/or others areas as assigned. Under the general direction of the Admitting Manager, this position focuses on registering patients for admission to hospital and/or outpatient procedures and services. This is a key position within Boulder City Hospital that directly affects the patient experience as well as the revenue cycle of the hospital. This role impact the organization through the proper registrations including but not limited to upfront collections of deductibles, co-pays and co-insurance, ensure insurance verifications and prior authorizations are done and submitted timely to reduce claim denials, communicate to the business office when a patient has insurance related issues or financial difficulties.
ESSENTIAL FUNCTIONS:
Admitting Representatives are expected to provide exceptional customer service to all patients, family members, visitors and vendors who come to the hospital to visit or to conduct business. Admitting Representatives are the first people seen when coming into the hospital and set the example for what patients and others will experience while being treated. This position registers patients, verifies patients’ insurance coverage, obtaining insurance pre-authorization when necessary, or on patients coming in when we are not notified in advance of registration for certain types of services not considered emergency services. Admitting Representatives should always communicate to the Admitting Manager and Director Patient Financial Services when insurances change that can affect the business office receiving payments and remits timely. Admitting Representatives are expected to follow EMTALA laws when working in the ER; they should be aware of their role in ensuring patients coming in to be treated are stabilized and treated regardless of their insurance or ability to pay. For emergency services, authorizations are obtained as soon as possible following requirements set by each company and following the Hospital policy. Admitting will also ensure that necessary notifications after normal business hours are followed according to the Admitting standards of practice. Answering phones and transferring calls to the appropriate individuals within BCH. Collecting and reconciling of daily cash. Directing vendors, visitors and patient family members to appropriate departments in hospital. Has the ability to lift, walk, carry and stand. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements are represented of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
DUTIES AND RESPONSIBILITIES:
- Responsible for answering incoming calls, transferring calls to the appropriate locations, assisting with placement of outgoing calls, contacting individuals by operating the overhead paging system and contacting individuals and agencies in case of an emergency.
- Responsible for handling patient inquiries and for directing and providing general information to visitors and the public. Ensure ALL visitors sign into Visitors log and are provided with badge to denote they are a “visitor”.
- Logs all patients coming in for labs, radiology and surgery in the “Outpatient Registration” book.
- Check census on the system as required. Locate and direct visitors and family to admitted patients.
- Reconcile the Admitting/ER Cash Box daily in morning and evening. Process meal ticket requests for employees, take and reconcile cafeteria monies collected from Cafeteria Manager daily, submit to Financial Counselor for deposit daily.
- Registers patient for admission to hospital, and/or outpatient procedures. Obtains and verifies all patient demographic information and payment source data, then inputs into computer system. Collect patient payments, issues receipts, reconcile and submit patient payments collected day of or previous day to be submitted to Financial Counselor for deposit.
- Receives requests for admissions and prepares paperwork for nursing personnel. Contacts the appropriate departments of patient’s readiness to be admitted and/or transferred. Enters medical orders into the computer system.
- Obtains ALL required signatures on consents and registration forms. Scans into patient’s chart.
- Identifies patient insurance coverage of primary and/or secondary insurance. Scans both the front and backs of insurances so they are legible. Verifies insurance coverage benefits including gaps in coverage, deductible, co-insurance, and out-of-pocket maximum amounts to estimate the out-of-pocket potentially owed by the patient for services. Scans insurance verifications into patient chart for review by billing department. Reports beneficiary coverage issues with patient insurance(s) to Admitting or DPFS to avoid payment issues. Obtains pre-authorizations when required by insurers for payments. Documents in patients chart the authorization details including expiration and services authorized for.
- Performs ABN’s as needed to verify covered services vs non covered services. Advises patient when ABN fails so patient is aware of possible out of pocket costs. This will determine if all or a portion of services will be performed. Obtains signed Medicaid and/or Medicare form from patient.
- Identifies payer web sites or other methods to verify coverage benefits.
- Call appropriate departments when patients are done with registration process to be escorted to designated areas for services.
- If clinic patients become inpatients, then notifies the review organizations or insurance companies of change in status, should an authorization now be required. The UR and Discharge Planning departments will also be notified.
- Follows EMTALA laws when patients present in the ER with needs. Ensures every patient coming into the ER is stabilized and treated regardless of their insurance or ability to pay.
- Procures patient valuables, documents, locks up in safe and handles per department policy.
- Observes all infection control policies.
- Must be able to stamp and distribute mail if needed.
- Keeps supplies ready by inventorying stock; placing orders; verifying receipt.
- Answers telephones for hospital and doctors’ answering service after hours as needed, take messages, locate the doctor and follow through with any instructions.
- Contacts appropriate departments when medical transportation services companies arrive to transfer a patient.
- Supports BCH Departments as need with special projects as given by the Supervisor, Manager or Director. Provide breakdown of pieces of mail stamped and costs if requested.
- Maintain records and log book for Pet visitors in the “Pink Pet Book”. Track, log, and maintain shot records for pets brought into facility to visit patients.
- Assist with Lost and Found requests as needed
- File complaints and grievances for patients when necessary.
- Perform Environment of Safety Checklist Monthly and submit to Maintenance Manager.
- Provide resource information when applicable for drug, abuse and neglect abuse hotlines or interpreter services.
- End of day lock up employee lists, meal tickets and receipts, key to cash box and TV remote.
- Nightly, set phones to roll over to ER at 8:00 pm. Announce through overhead paging when visiting time is over and request visitors to leave the hospital.
- Abides by all regulations, policies, work procedures, instructions, and safety rules.
SKILLS AND ABILITIES REQUIRED:
- Is proficient with hospital information system, especially subsystems related to admitting.
- Is able to work effectively and courteously with staff, physicians, medical office staff, patients and the public.
- Is able to work independently, requiring minimal supervision; exercising good judgment.
- Is able to communicate effectively with co-workers on all levels, verbally and in writing.
- Requires interpersonal skills necessary to communicate effectively with patients, patient families, referring parties.
- Knowledge of local and national provider insurances including but not limited to Sierra, Healthcare Partners, Hospital Coalition (HSPC), Medicare, Medicaid, BCBS, UHC, Aetna. Understanding of PPO and HMO insurance plans.
- Knowledge of insurance verification process, benefits, obtain patient eligibility by phone or insurance website.
- Knowledge of insurance benefits and coverage of medical benefit plan to patients (co-pay, co-insurance, deductibles, lifetime benefit, out-of-pocket maximum, CPT codes and Diagnosis codes.
- Knowledge of admission process
- Must have understanding of EMTALA Federal Law, regulations and guidelines for patients requiring services in the ER.
- Must possess good written and verbal communication skills.
- Maintains strictest confidentiality and adheres to all HIPAA guidelines and regulations
- Must possess computer skills and knowledge of other office equipment required for this position.
EDUCATION AND EXPERIENCE REQUIRED:
- High School Graduate or equivalent.
- Knowledge of medical and insurance terminology.
- Prior admitting experience preferred.
- Computer knowledge.
