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.
Instruct and review with patient, information concerning hospitalization. Ascertain health plan status, research eligibility and collect and copy non-KP insurance information.
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Identify all uninsured or under-insured patients admitted to facility; refer to Financial Counselors for further action.
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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.
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When Financial Counselor is available, discuss the need to obtain authorizations from non-KP insurers (including Medicare, Medi-Cal and COB).
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Promote patient satisfaction and retention through the successful facilitation of the revenue collection process.
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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.)
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Notify patient and when possible, collect financial liability for elective procedures.
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Document all interactions.
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Contact all discharged patients to attempt collection of financial liability. Document all interactions.
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Research payment records of all non-paying patients with liabilities, utilizing system records. Report findings to Manager/Supervisor/Designee.
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Analyze revenue data to determine obstacles in cost share collections. Report daily/weekly to Manager/Supervisor/Designee.
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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.
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Enter complete data into the KP information systems and review for accuracy per department, local, regional and regulatory compliance.
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Affix identification bracelet to the patients wrist on the side of the body opposite the intended procedure or injury per local policy.
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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.
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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.
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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.
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Obtain appropriate signatures on permits and consents per California Hospital Association (CHA) consent guidelines.
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Prepare related admission paperwork in advance to facilitate a timely admission process.
Assemble and coordinate admission materials to create a comprehensive admission package.
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Distribute relevant brochures/letters to patient/agent (e.g. Medicare letter, Coordination of Benefits (COB) brochure, advance directive brochure, cost share letter, etc.)
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Receive, document, secure and release patient valuables according to Standard Procedure 18A as appropriate.
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Initiate membership records on all newborns per local policy.
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Distribute admission materials to proper locations.
CUSTOMER SERVICE
Participate in problem-solving as needed to assure organizational revenue targets and customer satisfaction.
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Escort or arrange for patient escort to assigned room or area per local policy.
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Answer phones in a professional, courteous and positive manner promoting excellent customer relations when providing information/directions to physicians, staff and public.
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Maintain high standards of excellence and assist Kaiser Permanente fulfill its mission by providing high-quality health care services.
OTHER DUTIES
Work in a team environment continually enhancing required skills through scheduled training sessions or individually; attend required meetings, workshops and in-services.
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Provide support in conducting audits depending upon supervisory need.
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Perform other related duties as required.
Grade 5
Basic Qualifications:
Experience
Minimum six (6) months work experience required.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.
Education
High school diploma or equivalent.
License, Certification, Registration
N/A
Additional Requirements:
Basic knowledge and use of computer and computer keyboard (able to pass PC skills assessment).
Professional customer service skills.
Ability to read, write, understand and follow oral and written instructions.
Ability to effectively present information in one-on-one and small group situations to customers and other personnel within the organization.
Ability to use basic math.
Ability to work rapidly and accurately with phone, personnel and patient interruptions.
Ability to multitask, organize and prioritize and work independently with minimal supervision.
Proficient in admitting medical terminology (able to pass standardized test).
Must be willing to work in a Labor Management Partnership environment.
35 wpm typing or 6000 data entry keystrokes (able to pass either test).
Preferred Qualifications:
Hospital/clerical setting or medical office preferred.
Revenue collection experience preferred
COMPANY: KAISER
TITLE: Admitting Representative
LOCATION: Fresno, California
REQNUMBER: 1388771
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
