Senior Consumer Access Specialist FT Day East Orlando

• 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 pre-established 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

Quality Audits and Other Leadership Duties: 

• Assists department supervisor with quality audits as needed
• Demonstrates leadership skills through assisting with departmental training as needed
• Contributes to a positive work environment. Is open to change and is sensitive to department and organization needs
• Acts as a liaison to various departments as a knowledge leader
• Utilizes knowledge of and performs and educates team members on Guest Services functions to ensure the smooth operation of the Guest Services/Information department if applicable
• Works complex accounts and manages escalations from Consumer Access Representatives and Consumer Access Specialists
• 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
• Performs other duties as assigned

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

• 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

GENERAL SUMMARY:

Ensures 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. Works complex accounts and manages escalations from Consumer Access Representatives and Consumer Access Specialists. Assists with departmental training and quality audits. 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.