Consumer Access Specialist

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

Shift: Night Shift

Location: 410 SOUTH 11TH STREET, LAKE WALES, 33853

The community you’ll be caring for: AdventHealth Lake Wales

• AdventHealth Heart of Florida is a licensed 193-bed acute care hospital, coupled with outpatient services including imaging, rehab, lab and wound care, that has been serving the community for over 50 years.
• As a part of the AdventHealth network patients will have greater access to a wide range of innovative therapies, new research, leading-edge technology and an extensive team of medical specialists.
• High-quality care that has been recognized by the Joint Commission, the American Heart Association and the American Diabetes Association.
• Located in Davenport, FL., which is close to major destinations, like Busch Gardens, Legoland, and Walt Disney World, without being located in the central hub of tourism.

The role you’ll contribute:

Ensures patients are appropriately registered for all service lines. Performs eligibility verification, obtains pre-cert and/or authorizations, makes financial arrangements, requests and receives payments for services, performs cashiering functions, clears registration errors and edits pre-bill, and 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. Provides PBX (switchboard) coverage and support as needed.

The value you’ll bring to the team:

• 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 edit

The expertise and experiences you’ll need to succeed:

• High School Diploma or equivalent
• Mature judgement in dealing with patients, physicians, and insurance representatives
• Working knowledge of Microsoft programs and familiarity with database programs