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    Consumer Access Specialist - Durand, United States - Texas Health Huguley FWS

    Texas Health Huguley FWS
    Texas Health Huguley FWS Durand, United States

    1 month ago

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    Description
    Job Description - Consumer Access Specialist
    Job Description
    Consumer Access Specialist

    (


    Job Number:
    )
    Description
    Consumer Access Specialist – AdventHealth Durand
    All the benefits and perks you need for you and your family:
    Kind and caring staff
    Family atmosphere
    Competitive wages and great benefits

    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.
    Feel better. Feel whole.

    Trust AdventHealth Durand, formerly Chippewa Valley Hospital, in Durand, 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 you'll contribute:
    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.
    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. Provides PBX (switchboard) coverage and support as needed.

    The value you'll 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 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

    The expertise and experiences you'll 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 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:
    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
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