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Consumer Access Specialist - Durand, United States - Texas Health Huguley FWS
Description
Job Description - Consumer Access Specialist Job DescriptionConsumer Access Specialist (Job Number:
DescriptionConsumer Access Specialist AdventHealth DurandAll the benefits and perks you need for you and your family:Kind and caring staffFamily atmosphereCompetitive wages and great benefitsOur 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.Feel better. Feel whole. Trust AdventHealth Durand, formerlyChippewa Valley Hospital, inDurand, WI, to help everyone in the community enjoy the best possible care. Our hospital is here to help all our Pepin County neighbors experience a life of whole health.
The role youll contribute:
Ensures patients are appropriately registered for all service lines.
Performs eligibility verification, obtainspre-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.
Maintains a close working relationship with clinical partners to ensure continual open communicationbetween clinical, ancillary and patient access departments.Actively participates in extending exemplaryservice to both internal and external customers and accepts responsibility in maintaining relationships thatare equally respectful to all.
Provides PBX (switchboard) coverage and support as needed.The value youll bring to the team:
Proactively seeks assistance to improve any responsibilities assigned to their role Accountable for maintaining a working relationship with clinical partners to ensure opencommunications between clinical, ancillary, and patient access departments, which enhances thepatient experience Provides timely and continual coverage of assigned work area in order to offer prompt patient serviceand availability for all clinical partner registration needs.
Arranges relief coverage during extendedtime away from assigned registration area Meets and exceeds productivity standards determined by department leadership Meets attendance and punctuality requirements.
Maintains schedule flexibility to meet departmentneeds.Exhibits effective time management skills by monitoring time and attendance to limit use ofunauthorized overtime If applicable to facility, provides coverage for PBX (Switchboard) as needed, which includes:
fullshifts, breaks, and any scheduled/ unscheduled coverage requirements If applicable to facility, maintains knowledge of PBX (Switchboard), which includes: answeringphones, transferring calls or providing alternative direction to the caller, paging overhead codes, andcommunicating effectively with clinical areas to ensure code coverage.
If applicable to facility,knowledge of alarm systems and protocols and expedites code phone response.Maintains knowledgeof security protocol Actively attends department meetings and promotes positive dialogue within the teamInsurance Verification/Authorization:
Contacts insurance companies by phone, fax, online portal, and other resources to obtain and verifyinsurance eligibility and benefits and determine extent of coverage within established timeframebefore 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 physicianoffices to issues with verifying insurance Obtains pre-authorizations from third-party payers in accordance with payer requirements and withinestablished timeframe before scheduled appointments and during or after care for unscheduledpatients.
Accurately enters required authorization information in AdventHealth systems to includelength 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 onmissing or incomplete pre-authorizations with third-party payers to minimize authorization relateddenials 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 errorreports as requested by leadership and entering appropriate and accurate dataPatient Data Collection:
Minimizes duplication of medical records by using problem-solving skills to verify patient identitythrough demographic details Registers patients for all services (i.e.
emergency room, outpatient, inpatient, observation, same daysurgery, 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 determinecoverage.
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 securesthe 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 postcare financial needs.
Uses utmost caution that obtained benefits, authorizations, and pre-certificationsare correct and as accurate as possible to avoid rejections and/or denials.
Maintains a current andthorough knowledge of utilizing online eligibility pre-certification tools made available Delivers excellent customer service by contacting patients to inform them of authorization delays 48hours prior to their date of service and answers all questions and concerns patients may haveregarding authorization status Ensures consistent monitoring of interdepartmental tracking tools to proactively identify patients thatrequire registration to be completed.
Thoroughly documents all conversations with patients and insurance representatives - including payerdecisions, collection attempts, and payment plan arrangements Coordinates with case management staff as necessary (e.g., when pre-authorization cannot beobtained for an inpatient stay) Ensures patients have logistical information necessary to receive their services (e.g.
, appointment andtime, directions to facility)Payment Management:Creates accurate estimates to maximize up-front cash collections and adds collections documentationwhere required Calculates patients' co-pays, deductibles, and co-insurance.
Provides patients with personalizedestimates of their financial responsibility based on their insurance coverage or eligibility forgovernment programs prior to service for both inpatient and outpatient services Advises patients of expected costs and collects payments or makes appropriate payment agreementsin adherence to the AdventHealth TOS Collection Policy Attempts to collect patient cost-sharing amounts (e.g., co-pays, deductibles) and outstanding balancesbefore service.
Establishes payment plan arrangements for patients per established AdventHealthpolicy; clearly communicates due dates and amount of each installment. Collects payment planinstallments, out-of-pocket costs, outstanding previous balances, and any other applicable amountfrom patients per policy. Informs patients of any convenient payment options (e.g., portal, mobileapps) 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 financialcounselor if necessary Performs cashiering functions such as collections and cash reconciliation with accuracy in support ofthe pre-established legal and financial guidelines of AdventHealth when required Discusses financial arrangements for newborn(s), informs patient of the timeframe for enrolling anewborn in coverage, provides any documentation or guidance for the patient to enroll their childprior to or after the anticipated delivery date, and communicates appropriate information toregistration staff as neededQualificationsThe expertise and experiences youll need to succeed:
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 efficientfashion 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 AdventHealthcorporate policies
KNOWLEDGE AND SKILLS PREFERRED:
Understanding of HIPAA privacy rules and ability to use discretion when discussing patientrelated 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:
High School Grad or Equiv and 1+ years experience
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#J-18808-Ljbffr
