Consumer Access Specialist – AdventHealth Durand

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

• Mission driven organization

• Kind and caring staff

• Family atmosphere

• Competitive wages and great benefits

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 Days

Shift :

Monday-Thursday, 8:30am-5:00pm

Friday 8:30am-3:00pm

Location: AdventHealth Durand

1220 3rd Ave W, Durand, WI 54736

The community you’ll be caring for:

Feel better. Feel whole. Trust AdventHealth Durand, formerly Chippewa Valley Hospital, in Durand, WI, to help everyone in the community enjoy the best possible care. Our hospital is here to help all our Pepin County neighbors experience a life of whole health.

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:

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

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

• 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 - 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 payment plan

installments, out-of-pocket costs, outstanding previous balances, and any other applicable amount

from patients per 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

• Contacts patient to advise them of possible financial responsibility and connects them with a financial

counselor if necessary

• 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

The expertise and experiences you’ll need to succeed:

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:

High School Grad or Equiv and 1 years experience

EDUCATION AND EXPERIENCE PREFERRED:

• One year of relevant healthcare experience

• Prior collections experience

• One year of customer service experience

• One year of direct Patient Access experience

• Associate's degree

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Patient Financial Services

Organization: AdventHealth Durand

Schedule: Full-time

Shift: 1 - Day

Req ID: 24016830

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.