Consumer Access Specialist Patient Access FT Night East Orlando

• AdventHealth East Orlando, a 265-bed community hospital, has been serving East Orlando residents since 1941 as an innovative local leader that fills a vital need in a fast-growing area
• A recent 200,000 square-foot expansion project upgraded the hospital to 265 beds, with a spacious patient tower and 80 new private rooms designed to enhance the holistic care experience
• Annual number of emergency cases: 89,018

• 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

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