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PRINCIPAL DUTIES AND JOB RESPONSIBILITIES: *These are 11 hour shifts (2-4 shifts a week 22-44 hours)* 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 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 KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED: 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 EXPERIENCE PREFERRED: 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: 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 LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED: LICENSURE, CERTIFICATION OR REGISTRATION: · n/a SUPERVISORY RESPONSIBILITIES · n/a LIVING OUR SERVICE STANDARDS · How we treat those we serve and each other is what sets us apart from other healthcare organizations. We want everyone · who walks through our doors to feel loved, cared for, and at ease. Whether you are clinical or non-clinical, your actions · and behaviors can create an environment that either builds trust or causes anxiety and fear. We have made it easy for you · to ensure that you are always building trust and providing excellent care by exhibiting our Service Standards. · All team members will be held accountable for consistently living out our 16 Service Standards and the additional · behaviors listed below to ensure that every person, every time has an exceptional experience. KEEP ME SAFE · I make safety my number one priority. · I protect privacy and confidentiality. · I keep my environment clean. · I follow the dress code and wear my badge correctly. LOVE ME · I treat others with uncommon compassion. · I nurture whole-person care through CREATION Health. · I treat others with fairness and respect. · I listen and communicate using iCARE. (Introduce, Connect, Anticipate, Reinforce, Extend) MAKE IT EASY · I help guests to their destination. · I speak highly of others to provide connected care. · I collaborate to create solutions, not excuses. · I innovate and continually seek ways to improve our work. OWN IT · I am positive and aim to exceed all expectations. · I follow through on commitments. · I use discretion with personal devices. · I recover service and restore trust using ACT. (Acknowledge/Apologize, Correct, Thank) · Team members must conform to all AdventHealth organizational and departmental policies and procedures including but not limited to: o Code of Conduct as outlined in the "Guidelines for Employees" handbook · Establishes and maintains a history of regular attendance; makes appropriate use of PDO and observes department call-in · procedures for absence; establishes and maintains punctual work habits. Exhibits timely arrival and departure and · dependable time habits including meal and other breaks. · Attends and participates in mandatory facility-wide and department training/meetings as required (including but not · limited to: ALN, safety training, etc.). Is able to demonstrate and apply knowledge of fire, safety, security, and disaster · procedure regulations as presented in orientation, outlined in the safety manual, and as pertains to each work area. · Required to respond to emergency situations (i.e. disasters, hurricanes, etc.) by reporting to department and staying until the crisis is over or your position is covered by incoming personnel. This is a mandatory requirement. Refusal to respond may result in termination. · Contributes to the successful achievement of department-stated goals and objectives and will facilitate staff cohesiveness and communication. REQUIRED COMPETENCIES · Accurately identifies and assigns payer plan codes in organization's electronic health record system; utilizes knowledge · of insurance plans and contracts to identify opportunities to improve payer master file · Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed · Demonstrates expert understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.) and analyzes information received to determine patients' out-of-pocket liabilities · This position description reflects the general duties and responsibilities necessary to describe the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. The responsibilities listed may be subject to change at any time and individuals may be asked to perform duties outside of their regular responsibilities to support the ongoing operations of AdventHealth and its facilities. |