Consumer Access Specialist FT Day AdventHealth Wesley Chapel

Location Address: 2600 Bruce B. Downs Blvd Wesley Chapel, Florida 33544

Top Reasons to Work at AdventHealth Wesley Chapel

• From state- of- the- art equipment to the most intricate building details, AdventHealth Wesley Chapel was designed from the ground up to maximize healing, patient care and wellness
• Recognized as leader in patient satisfaction and was named Top 100 Hospital in Modern Healthcare Magazine by IBM Watson Health
• 50,000 sq ft community Health & Wellness Center
• Comprehensive women’s health center named Inspiration Place that incorporates female physician specialists, women’s imaging, pelvic floor and female physical therapy and a boutique spa.
• Consistently named a Top Workplace in Tampa Bay by the Tampa Bay Times
• Opened an offsite 24 bed, 24/7 emergency room in Central Pasco to better serve the emergency health needs of residents in west and central Pasco

Work Hours/Shift:

Full Time Day

YOU ARE REQUIRED TO SUBMIT A RESUME WITH YOUR APPLICATION!

You Will Be Responsible For:

 General Duties:

• 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 

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

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

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.
• Connects patients with financial counseling or Medicaid eligibility vendor as appropriate
• Contacts patient to advise them of possible financial responsibility and connects

What You Will Need:

KNOWLEDGE AND SKILLS REQUIRED:

• 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 SKILLS 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:

• One year of customer service experience
• High School diploma or GED

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’s degree

Job 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. Provides PBX (switchboard) coverage and support as needed.