GL-Consumer Access Spec Lead

at AdventHealth in Hinsdale, Illinois, United States

Job Description

GENERAL 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. Works complex accounts and manages escalations

from Consumer Access Representatives and Consumer Access Specialists. Assists with departmental training and quality

audits. Maintains a close working relationship with clinical partners to ensure continual open communication between

clinical, ancillary and patient access departments. Anticipates and responds to the inquires and needs of clinical partners.

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.

Ensures team success in active mentoring and meeting the stated monthly collection and accuracy goals. Monitors team

performance. Carries out implementation of supervisor/manager directive.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

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. Arranges relief coverage during extended time away from assigned registration

area

-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

-If applicable to facility, provides coverage for PBX (Switchboard) as needed, which includes: full shifts, breaks, and

any scheduled/ unscheduled coverage requirements

-If applicable to facility, maintains knowledge of PBX (Switchboard), which includes: answering phones, transferring

calls or providing alternative direction to the caller, paging overhead codes, and communicating effectively with clinical

areas to ensure code coverage. If applicable to facility, knowledge of alarm systems and protocols and expedites code

phone response. Maintains knowledge of security protocol

-Actively attends department meetings and promotes positive dialogue within the team

-Performs other duties as assigned

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

-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

-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

-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

-Ensures consistent monitoring of interdepartmental tracking tools to proactively identify patients that require

registration to be completed.

-Thoroughly documents all conversations with patients and insurance representatives in the appropriate fields in the

registration conversation – 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).

-Ensures patients have logistical information necessary to receive their services (e.g., appointment and time, directions

to facility)

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. Collects payme