HMO/Admitting Staff

Key Responsibilities

• Register patients for inpatient, outpatient, and emergency services
• Verify HMO membership, insurance coverage, and patient eligibility
• Secure approvals, authorizations, and guarantees of payment (GOP) from HMOs
• Coordinate with physicians, nurses, and billing staff regarding patient admissions and coverage
• Explain insurance benefits, limitations, and payment responsibilities to patients
• Ensure all admission forms, consent forms, and insurance documents are complete and accurate
• Maintain accurate records in the hospital information system
• Monitor and follow up on pending HMO approvals
• Ensure compliance with hospital policies, HMO guidelines, and HIPAA regulations
• Assist in discharge processing and insurance-related clearances