Established in 1908, AdventHealth is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.
The Pre-Access team is responsible for verifying eligibility, creating estimates, and securing authorization for the patients OP or IP visit. The services covered include Imaging, Surgery, Rehab and Inpatient admissions.
Monday – Friday 5/8s; 10:30am – 7pm
The Pre-Access Financial Clearance Specialist, under general supervision, maintains performance standards appropriate to area by obtaining account benefits and/or verifying authorizations are in place for all scheduled, unscheduled patient accounts under responsibility, and meeting time line standards established by leadership for all patient services. Meets or exceeds department audit accuracy and productivity standard goal. Uses utmost caution that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test, and procedure or registration being performed. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Knowledge, Skills, Education, & Experience Required:
- Ability to use discretion when discussing personnel and patient related issues that are confidential in nature
- Responsive to ever-changing matrix of hospital needs and acts accordingly
- Self-motivator, and quick thinker
- Proficient in Microsoft Office Programs such as Outlook, Word, and Excel
- Proficiency in performance of basic math functions, capability of communicating professionally and effectively in English, both verbally and in writing
- One (1) year experience in Patient Financial Services, Patient Access, Customer Service or related area (registration, finance, collections, customer service, medical office, or contract management)
- Associate’s Degree and/or higher-level education or completed coursework (Preferred)
Demonstrates through behavior AdventHealth’s Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization’s Performance Excellence Program
- Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information. Updates AdventHealth systems with accurate information obtained. Responsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel.
- Meets or exceeds audit accuracy and productivity standard goals determined by Pre-Access leadership, while meeting timeline standards established by leadership for all patient services. Ensures integrity of patient accounts by working error reports as requested by management and entering appropriate and accurate data. Works with inpatient accounts for authorization, and held responsible for timely notification to payers of the patient’s admission to the facility to protect financial standing of AdventHealth.
- Uses utmost caution that obtained benefits, authorizations, and pre-certifications are accurate according to the actual test and procedure or registration being performed. Ensures all benefits, authorizations, pre-certifications, and financial obligations of patients, are documented on account memos, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts. When working under Rehab PA POS Float designation: Provides coverage for designated Rehab Centers that have POS representatives that report to Pre-Access; must have reliable transportation as there are various locations in the tri-county area; may be notified of coverage needs at a short notice when warranted. Duties include scanning, collection, batching deposits; RMAU and reverifications.
- Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services departments. May contact physicians, Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payor, as assigned.
- Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related Pre-Access account issues, within defined time frames. Exhibits effective time management skills and maintains flexibility by being available for all partners and team. May assists team with reports and projects to maintain team and individual productivity standards and goals.
- Works patient accounts for benefits, monitors accounts for change in insurance status prior to registration and sends updates to appropriate areas for follow up. Works patient accounts for pre-certification, contacts physician, Patient Access staff, and clinical service area where appropriate, notifying authorization is not obtained by department deadline, advising of visit cancellation, reschedule, or to obtain life or limb order from physician allowing patient to proceed. Contacts patient to notify when visit is rescheduled.
- Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime. Maintains sign-on access to online tools to provide consistent service to patients, clinical partners, and Patient Access team members.
- Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Pre-Access Financial Clearance Specialist opportunity with AdventHealth Maitland and apply online today.
Pre-Access Financial Clearance Specialist, Maitland