Description
All the benefits and perks you need for you and your family:
Benefits from Day One
Paid Days Off from Day One
Student Loan Repayment Program
Career Development
Whole Person Wellbeing Resources
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind, and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full Time
Shift : Monday – Friday (days) 8am-4:30pm
The community you will be caring for: AdventHealth Daytona - 301 Memorial Medical Pkwy, Daytona Beach, FL 32117
The role you will contribute:
As a Consumer Access Specialist, you will ensure patients are appropriately registered for all service lines. Performs eligibility verification, obtains pre-cert and/or authorizations, makes financial arrangements, requests, and receives payments for services, performs cashiering functions, clears registration errors and edits pre-bill, and other duties as required. Maintains a close working relationship with clinical partners to ensure continual open communication between clinical, ancillary, and patient access departments. Actively participates in extending exemplary service to both internal and external customers and accepts responsibility in maintaining relationships that are equally respectful to all. Provides PBX (switchboard) coverage and support as needed.
The value you will bring to the team:
Proactively seeks assistance to improve any responsibilities assigned to their role
Accountable for maintaining a working relationship with clinical partners to ensure open communications between clinical, ancillary, and patient access departments, which enhances the patient experience
Provides timely and continual coverage of assigned work area in order to offer prompt patient service and availability for all clinical partner registration needs. Arranges relief coverage during extended time away from assigned registration area
Meets and exceeds productivity standards determined by department leadership
Meets attendance and punctuality requirements. Maintains schedule flexibility to meet department needs. Exhibits effective time management skills by monitoring time and attendance to limit use of unauthorized overtime
If applicable to facility, provides coverage for PBX (Switchboard) as needed, which includes: full shifts, breaks, and any scheduled/ unscheduled coverage requirements
If applicable to facility, maintains knowledge of PBX (Switchboard), which includes: answering phones, transferring calls or providing alternative direction to the caller, paging overhead codes, and communicating effectively with clinical areas to ensure code coverage. If applicable to facility, knowledge of alarm systems and protocols and expedites code phone response. Maintains knowledge of security protocol
Actively attends department meetings and promotes positive dialogue within the team
Insurance Verification/Authorization:
Contacts insurance companies by phone, fax, online portal, and other resources to obtain and verify insurance eligibility and benefits and determine extent of coverage within established timeframe before scheduled appointments and during or after care for unscheduled patients
Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the patient. Alerts physician offices to issues with verifying insurance
Obtains pre-authorizations from third-party payers in accordance with payer requirements and within established timeframe before scheduled appointments and during or after care for unscheduled patients. Accurately enters required authorization information in AdventHealth systems to include length of authorization, total number of visits, and/or units of medication
Obtains PCP referrals when applicable
Alerts physician offices to issues with obtaining pre-authorizations. Conducts diligent follow-up on missing or incomplete pre-authorizations with third-party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as needed
Submits notice of admissions when requested by facility
Corrects demographic, insurance, or authorization related errors and pre-bill edits
Meets or exceeds accuracy standards and ensures integrity of patient accounts by working error reports as requested by leadership and entering appropriate and accurate data
Patient Data Collection:
Minimizes duplication of medical records by using problem-solving skills to verify patient identity through demographic details
Registers patients for all services (i.e. emergency room, outpatient, inpatient, observation, same day surgery, outpatient in a bed, etc.) and achieves the department specific goal for accuracy
Responsible for registering patients by obtaining critical demographic elements from patients (e.g., name, date of birth, etc.)
Confirms whether patients are insured and, if so, gathers details (e.g., insurer name, plan subscriber)
Performs Medicare compliance review on all applicable Medicare accounts in order to determine coverage. Identifies patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs). Issues ABN forms as needed
Performs eligibility check on all Medicare inpatients to determine HMO status and available days. Communicates any outstanding issues with Financial Counselors and/or case management staff
Completes Medicare Secondary Payer Questionnaire for Medicare beneficiaries
Properly identifies patients, ensures armband accuracy, inputs demographics information, and secures the required forms to ensure compliance with regulatory policies
Ensures patient accounts are assigned the appropriate payor plans
Ensures all financial assessments, eligibility, and benefits are updated and thorough to support post care financial needs. Uses utmost caution that obtained benefits, authorizations, and pre-certifications are correct and as accurate as possible to avoid rejections and/or denials.
Maintains a current and thorough knowledge of utilizing online eligibility precertification tools made available
Delivers excellent customer service by contacting patients to inform them of authorization delays 48 hours prior to their date of service and answers all questions and concerns patients may have regarding authorization status
Ensures consistent monitoring of interdepartmental tracking tools to proactively identify patients that require registration to be completed.
Thoroughly documents all conversations with patients and insurance representatives - including payer decisions, collection attempts, and payment plan arrangements
Coordinates with case management staff as necessary (e.g., when pre-authorization cannot be obtained for an inpatient stay)
Ensures patients have logistical information necessary to receive their services (e.g., appointment and time, directions to facility)
Payment Management:
Creates accurate estimates to maximize up-front cash collections and adds collections documentation where required
Calculates patients' co-pays, deductibles, and co-insurance. Provides patients with personalized estimates of their financial responsibility based on their insurance coverage or eligibility for government programs prior to service for both inpatient and outpatient services
Advises patients of expected costs and collects payments or makes appropriate payment agreements in adherence to the AdventHealth TOS Collection Policy
Attempts to collect patient cost-sharing amounts (e.g., co-pays, deductibles) and outstanding balances before service. Establishes payment plan arrangements for patients per established AdventHealth policy; clearly communicates due dates and amount of each installment. Collects payment plan installments, out-of-pocket costs, outstanding previous balances, and any other applicable amount from patients per policy. Informs patients of any convenient payment options (e.g., portal, mobile apps) and follows deferral procedure as required
Connects patients with financial counseling or Medicaid eligibility vendor as appropriate
Contacts patient to advise them of possible financial responsibility and connects them with a financial counselor if necessary
Performs cashiering functions such as collections and cash reconciliation with accuracy in support of the preestablished legal and financial guidelines of AdventHealth when required
Discusses financial arrangements for newborn(s), informs patient of the timeframe for enrolling a newborn in coverage, provides any documentation or guidance for the patient to enroll their child prior to or after the anticipated delivery date, and communicates appropriate information to registration staff as needed
Qualifications
KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:
Mature judgement in dealing with patients, physicians, and insurance representatives
Working knowledge of Microsoft programs and familiarity with database programs
Ability to operate general office machines such as computer, fax machine, printer, and scanner
Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion
Ability to communicate professionally and effectively, both verbally and written
Ability to adapt in ever changing healthcare environment
Ability to follow complex instructions and procedures, with a close attention to detail
Adheres to government guidelines such as CMS, EMTALA, and HIPPAA and AdventHealth corporate policies
KNOWLEDGE AND EXPERIENCE PREFERRED:
Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature as needed to perform duties
Knowledge of computer programs and electronic health record programs
Basic knowledge of medical terminology
Exposure to insurance benefits; ability to decipher insurance benefit information
Bilingual – English/Spanish
EDUCATION AND EXPERIENCE REQUIRED:
- High School Diploma or Equivalent
EDUCATION AND EXPERIENCE PREFERRED:
One year of relevant healthcare experience
Prior collections experience
One year of customer service experience
One year of direct Patient Access experience
Associate degree
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
Category: Patient Financial Services
Organization: AdventHealth Daytona Beach
Schedule: 1 - Day
Shift: AdventHealth Daytona Beach
Req ID: 23005388
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
