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GL-Consumer Access Spec Lead

1 month ago

Hinsdale, United States UChicago Medicine AdventHealth Great Lakes Full time

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. Anticipates and responds to the inquires and needs of clinical partners.

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.

Ensures team success in active mentoring and meeting the stated monthly collection and accuracy goals. Monitors team

performance. Carries out implementation of supervisor/manager directive.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

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

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

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 pre certification 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 in the appropriate fields in the

registration conversation - 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 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 mentoring staff and 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

Assists with Human Resource functions, including evaluation, scheduling, and productivity

Communicates educational needs for improvement on performance, processes, and workflows to leadership via email,

one-on-one, and/or team meetings

Leads monthly team meetings and team huddles

SCHEDULE: M-F 3:00PM-11:30PM rotating weekend on-call

Qualifications

KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:

Mature judgement in dealing with patients, physicians, and insurance representatives

Intermediate 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 HIPAA and AdventHealth corporate policies

Exceptional customer service skills

Advanced understanding of insurance knowledge and benefits

Advanced understanding of hospital electronic medical report (EMR) system

Basic medical terminology

Must be able to read, write, and speak conversational English

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

Intermediate medical terminology

Bilingual English/Spanish

EDUCATION AND EXPERIENCE REQUIRED:

High School Grad or Equiv and 1 years experience

EDUCATION AND EXPERIENCE:

EDUCATION AND EXPERIENCE PREFERRED:

Two years of direct Patient Access experience

Associate's degree in Health Services or completed coursework related to Health Services

N/A

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

Certified Healthcare Access Associate (CHAA)

Certified Revenue Cycle Representative (CRCR)

SUPERVISORY RESPONSIBILITIES

Helps management with training and supervising Consumer Access Representative, Consumer Access Specialist, and

Senior Consumer Access Specialist in daily activities

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Patient Financial Services

Organization: UChicago Medicine AdventHealth Hinsdale

Schedule: Full-time

Shift: 3 - Night

Req ID: 24024621

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.