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
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
Minimizes duplication of medical records by using problem-solving skills to verify patient identity through demographic details
Identifies patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
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)
Creates accurate estimates to maximize up-front cash collections and adds collections documentation where required
Calculates patientsâ™ 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
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.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.