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Consumer Access Specialist - AdventHealth - WINTER PARK
Top Reasons to work at AdventHealth - WINTER PARK
Winter Park Memorial Hospital has continuously served the residents of Winter Park and its surrounding communities for more than 50 years
Chartered in 1951, the hospital has grown from the visionary efforts of a handful of Winter Park residents and community leaders, to a 307-bed acute care facility that is a model of community health and wellness
Over the years the hospital has continually expanded to meet the needs of the community, adding an upscale obstetrics and Level II Neonatal Intensive Care Unit at The Dr. P. Phillips Baby Place, cancer care at the AdventHealth Cancer Institute, Winter Park, and state-of-the-art surgery, recovery and rehabilitation at the AdventHealth Orthopaedic Institute
Work Hours/Shift: Full Time Flex
You Will Be Responsible For:
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
What You Will Need:
One year of customer service experience
High School diploma or GED
One year of relevant healthcare experience
One year of customer service experience
Prior collections experience
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.