Lead Consumer Access Specialist

GENERAL SUMMARY:
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. Works complex accounts and manages escalations
from Consumer Access Representatives and Consumer Access Specialists. Assists with departmental training and quality
audits. Maintains a close working relationship with clinical partners to ensure continual open communication between
clinical, ancillary and patient access departments. Anticipates and responds to the inquires and needs of clinical partners.
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.
Ensures team success in active mentoring and meeting the stated monthly collection and accuracy goals. Monitors team
performance. Carries out implementation of supervisor/manager directive.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
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
• Performs other duties as assigned
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
• 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 precertification 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 in the appropriate fields in the
registration conversation - 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 preestablished 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
Quality Audits and Other Leadership Duties:
• Assists department supervisor with quality audits as needed
• Demonstrates leadership skills through mentoring staff and assisting with departmental training as needed
• Contributes to a positive work environment. Is open to change and is sensitive to department and organization needs
• Acts as a liaison to various departments as a knowledge leader
• Utilizes knowledge of and performs and educates team members on Guest Services functions to ensure the smooth
operation of the Guest Services/Information department if applicable
• Works complex accounts and manages escalations from Consumer Access Representatives and Consumer Access
Specialists
• Assists with Human Resource functions, including evaluation, scheduling, and productivity
• Communicates educational needs for improvement on performance, processes, and workflows to leadership via email,
one-on-one, and/or team meetings
• Leads monthly team meetings and team huddles

SCHEDULE: M-F 3:00PM-11:30PM rotating weekend on-call

Qualifications
KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:
• Mature judgement in dealing with patients, physicians, and insurance representatives
• Intermediate 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 HIPAA and AdventHealth corporate policies
• Exceptional customer service skills
• Advanced understanding of insurance knowledge and benefits
• Advanced understanding of hospital electronic medical report (EMR) system
• Basic medical terminology
• Must be able to read, write, and speak conversational English
KNOWLEDGE AND EXPERIENCE 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
• Intermediate medical terminology
• Bilingual - English/Spanish

EDUCATION AND EXPERIENCE REQUIRED:
High School Grad or Equiv and 1+ years experience

EDUCATION AND EXPERIENCE:
EDUCATION AND EXPERIENCE PREFERRED:
• Two years of direct Patient Access experience
• Associate's degree in Health Services or completed coursework related to Health Services

• N/A
LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:
• Certified Healthcare Access Associate (CHAA)
• Certified Revenue Cycle Representative (CRCR)

SUPERVISORY RESPONSIBILITIES
Helps management with training and supervising Consumer Access Representative, Consumer Access Specialist, and
Senior Consumer Access Specialist in daily activities

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