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
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)
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
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
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.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.