Consumer Access Specialist

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. Its 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: Part Time

Shift : 24

Location: 210 Marie Langdon Drive, Manchester, KY 40962

The community youll be caring for: AdventHealth Manchester

Surrounded by beautiful forests and wildlife

Known as The Gateway To The Redbud Capital of Kentucky

Enjoy 3,150 acres of off-roading trails

Home to the historical swinging bridges of Clay County

Rich Appalachian history and culture

Declared Elk Capital of the East

Over 600 miles of trails provided by the Daniel Boone National Forest

The role youll contribute:

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

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 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 - 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

Qualifications

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

Associates degree

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: AdventHealth Manchester

Schedule: Part-time

Shift: 1 - Day

Req ID: 24026729

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.