Consumer Access Specialist ( Patient Access) Full Time Day AdventHealth Zephyrhills

Location Address: 7050 Gall Boulevard Zephyrhills, Florida 33541

Top Reasons to Work at AdventHealth Zephyrhills

• FH Zeph/Dade City Named One of America’s Best Hospitals for Heart Care, Orthopedics, Stroke Centers and Patient Safety three years in a row “2017-2019” by the Women’s Choice Award
• Leapfrog Hospital Safety Grade A Spring/Fall 2018
• One of only 35 Hospitals Nationally Named as a Top General Hospital by The Leapfrog Group
• Four Star Recipient for Coronary Interventional Procedures in 2019 by Health grades
• First in Florida to earn Advanced Certification for Total Hip and Total Knee by The Joint Commission

Work Hours/Shift:

Full Time Day Monday - Friday 7:00am to 4:00pm

YOU ARE REQUIRED TO SUBMIT A RESUME WITH YOUR APPLICATION!           

You Will Be Responsible For:

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.
• Meets and exceeds productivity standards determined by department leadership
• Meets attendance and punctuality requirements. Maintains schedule flexibility to meet department needs

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
• 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

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.
• 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

What You Will Need:

 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:

• One year of relevant healthcare experience
• One year of customer service experience
• Prior collections experience
• High School diploma or GED
• One year of direct Patient Access experience preferred
• Associate’s degree preferred

Job Summary:

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.