Consumer Access Specialist

Description - External

All the benefits and perks you need for you and your family:

Benefits from Day One

- Paid Days Off from Day One

- Student Loan Repayment Program

- Career Development

- Whole Person Wellbeing Resources

- Mental Health Resources and Support

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.

Schedule: Full Time

Shift : Night

Location: AdventHealth Avista

100 Health Park Drive, Louisville, CO 80027

The community you'll be caring for:

AdventHealth Avista is a comprehensive medical center known for compassionate, high-quality, whole person care. This 114-bed full-service community hospital provides a wide range of medical specialties and exceptional, innovative health care to the communities of Louisville, Superior Broomfield and surrounding areas. The hospital's caregivers are passionate about AdventHealth's mission of Extending the Healing Ministry of Christ and nurturing the health of the people in their communities.

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:

• 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.
• If applicable to facility, provides coverage for PBX (Switchboard) as needed, which includes: full shifts, breaks, and any scheduled/ unscheduled coverage requirements
• 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 or pre-aurthorizations
• 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
• Minimizes duplication of medical records by using problem-solving skills to verify patient identity through demographic details
• Registers patients for all services and achieves the department specific goal for accuracy
• Responsible for registering patients by obtaining critical demographic elements from patients
• Confirms whether patients are insured and gathers necessary details
• Performs Medicare compliance review on all applicable Medicare accounts in order to determine coverage.
• 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
• 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
• 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
• Coordinates with case management staff as necessary
• 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
• 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 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

Qualifications

The expertise and experiences you'll need to succeed:

Education and Experience Required

• High school diploma or GED
• 1+ year of experience

Education and Experience Preferred

• One year of relevant health care experience
• Prior collections experience
• One year of customer service experience
• One year of direct Patient Access experience
• 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
• Associate degree