Consumer Access SpecialistWinter Garden, FL

Consumer Access Specialist

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

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
• Pet Insurance*
• Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)

Schedule: Full Time

Shift: 8p-6:30a Monday-Thursday

Location: 13323 HARTZOG RD, Winter Garden, 34787

The community you'll be caring for:

• Faith based & mission driven organization
• Central Florida's premier multi-specialty medical group
• Comprehensive Employee Benefits such as Educational Reimbursement
• CREATION Health employee wellness and lifestyle programs
• Positive working climate to support a work life balance

The role you'll contribute:

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.

The value you'll bring to the team:

• 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

The expertise and experiences you'll need to succeed:

Required:

• One year of customer service experience
• High School diploma or GED

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