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Consumer Access Specialist

1 month ago

Clermont, United States AdventHealth Full time

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
  • Mental Health Resources and Support
  • Pet Insurance*
  • Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)

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

Location: 1909 E HWY 50, Clermont, 34711

  • Faith based & mission driven organization
  • Central Florida’s premier multi-specialty medical group
  • Comprehensive Employee Benefits such as Educational Reimbursement
  • CREATION Health employee wellness and lifestyle programs
  • Positive working climate to support a work life balance

The role you’ll contribute: 

Ensures patients are appropriately financially cleared for all appointments. Performs eligibility verification, obtains pre-cert and/or authorizations, clears registration errors and edits pre-bill, and performs 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. 

Job Keywords: Registration Representative, Authorization Representative, Patient Registration, PreAccess, Maitland

The value you’ll bring to the team:

  • Proactively 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
  • Meet department standard when obtaining 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
  • Maintain close working relationship with clinical partners and physician offices to resolve 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
  • Minimizes duplication of medical records by using problem-solving skills to verify patient identity through demographic details
  • 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
  • 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)
  • Adheres to HIPAA regulations by verifying information to determine caller authorization level receiving information on account.
  • Creates accurate estimates to maximize up-front cash collections and adds collections documentation where required
  • Calculates patients’ co-pays, deductibles, and co-insurance. Provides personalized estimates of patient financial responsibility based on their insurance coverage or eligibility for government programs prior to service for both inpatient and outpatient services

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