Consumer Access Specialist Lead

AdventHealth•Pleasant Hill, CA

9h•Onsite

About The Position

Manages relationships with clinical partners to ensure open communication between clinical, ancillary, and consumer access departments. Provides timely and continual coverage of assigned work areas to offer prompt patient service and availability for all clinical partner registration needs. Provides on-call support as needed. Contacts insurance companies to verify insurance eligibility and benefits, and determine coverage before scheduled appointments and during or after care for unscheduled patients. Obtains pre-authorizations from third-party payers and accurately enters required authorization information in the system. Registers patients for all services by obtaining critical demographic elements and ensuring accuracy. Performs Medicare compliance reviews, eligibility checks, and completes Medicare Secondary Payer Questionnaires. Ensures patient accounts are assigned the appropriate payor plans and updates financial assessments, eligibility, and benefits. Creates accurate estimates to maximize up-front cash collections and advises patients of expected costs, collecting payments or making appropriate payment agreements. Assists department supervisor with quality audits, mentoring staff, assisting with departmental training, and staff schedules. Coordinates with case management staff as necessary and ensures patients have logistical information necessary to receive their services. Documents all conversations with patients and insurance representatives in the appropriate fields. Actively attends department meetings and promotes positive dialogue within the team. Other duties as assigned.

Requirements

Mature judgement in dealing with patients, physicians, and insurance representatives
Intermediate 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 HIPAA and corporate policies
Exceptional customer service skills
Advanced understanding of insurance knowledge and benefits
Advanced understanding of hospital electronic medical report (EMR) system
Basic medical terminology
Must be able to read, write, and speak conversational English
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
Intermediate medical terminology
High School Grad or Equiv [Required]
1+ customer service experience [Required]
1+ revenue cycle experience [Required]

Nice To Haves

Associate [Preferred]
2+ direct patient access experience [Preferred]
Certified Healthcare Access Associate (CHAA) [Preferred]
Certified Revenue Cycle Rep (CRCR) [Preferred]
Bilingual – English/Spanish

Responsibilities

Manages relationships with clinical partners to ensure open communication between clinical, ancillary, and consumer access departments.
Provides timely and continual coverage of assigned work areas to offer prompt patient service and availability for all clinical partner registration needs.
Provides on-call support as needed.
Contacts insurance companies to verify insurance eligibility and benefits, and determine coverage before scheduled appointments and during or after care for unscheduled patients.
Obtains pre-authorizations from third-party payers and accurately enters required authorization information in the system.
Registers patients for all services by obtaining critical demographic elements and ensuring accuracy.
Performs Medicare compliance reviews, eligibility checks, and completes Medicare Secondary Payer Questionnaires.
Ensures patient accounts are assigned the appropriate payor plans and updates financial assessments, eligibility, and benefits.
Creates accurate estimates to maximize up-front cash collections and advises patients of expected costs, collecting payments or making appropriate payment agreements.
Assists department supervisor with quality audits, mentoring staff, assisting with departmental training, and staff schedules.
Coordinates with case management staff as necessary and ensures patients have logistical information necessary to receive their services.
Documents all conversations with patients and insurance representatives in the appropriate fields.
Actively attends department meetings and promotes positive dialogue within the team.
Other duties as assigned.