Job Description

Job Description

Description
What 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
* Monitors work queues throughout to day to ensure patient accounts are worked timely and in accordance with established service line leader expectations
* 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
* 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
* 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)

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 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

Qualifications
What You Will Need:

* 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 diploma or GED

EDUCATION AND EXPERIENCE PREFERRED:

* * One year of relevant healthcare experience
* One year of customer service experience
* Prior collections experience
* Associates degree

Job Summary:

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.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.