The Pre-Access representative is responsible for gathering patient and guarantor demographic and insurance information; verifying insurance eligibility and benefits, ensuring pre-certifications and authorizations is obtained and validated; computing, communicating and initiating patient liability collections and initiating the financial clearance process for scheduled patients
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
Â· Pre-registers scheduled patients by gathering all patient demographic and financial information.
Â· Enters pre-registration information for patients using online pre-registration, validates complete information is obtained and contacts patients for missing or incomplete information.
Â· Ensures accurate use of the hospital system and proper identification of each patient by searching the hospital system by social security number, last name, first name and date of birth for previously assigned numbers as documented by HIM.
Â· Verifies insurance eligibility and benefits. Obtains and validates applicable pre-certifications and authorizations.
Â· Enters correct financial class and payer codes. Enters correct clinical information regarding physician, complaint, and diagnosis. Computes patient liability and completes medical necessity checks, as applicable.
Â· Communicates and initiates patient liability collections. Prepares all appropriate documentation for pending date of service. Ensures physician orders are obtained and alerts Registration of potential issues prior to patient arrival.
Â· Alerts Financial Advocates of accounts with financial clearance issues.
Â· Achieves 98% accuracy rating at the conclusion of the 90 day probationary period and maintains 98% on an ongoing basis. Achieves department upfront collection goals by working with leadership and associates to ensure success. Achieves departmental guidelines for avoidable denials as established by the department.
Â· Responsible for adhering to the hospital Corporate Compliance plan, Policies and Procedures and to the rules and regulations of all local, state and Federal agencies and to the standards of all accrediting bodies.
Â· Is responsible for performing and completing of any other tasks or projects assigned by the Director and/or Manager.
KNOWLEDGE AND SKILLS REQUIRED:
Â· Most work is competitive and new situations arise frequently which require good judgment in the application of policies and procedures.
Â· Must demonstrate good planning, attention to detail, and take initiative to resolve immediate or urgent problems.
Â· Must be able to coordinate multiple projects at the same time and maintain a positive and professional demeanor
Â· Must be a quick learner and have excellent memory in order to process registrations in a courteous, professional, and timely manner.
Â· Must have good interpersonal skills and knowledge of medical terminology. Must be able to effectively communicate professionally in English both orally and in writing, as well as proficiency in the performance of basic math functions.
Â· Must have typing skills of at least 45 wpm.
EDUCATION AND EXPERIENCE REQUIRED:
Â· A high school diploma or the equivalent is required.
EDUCATION AND EXPERIENCE PREFERRED:
Â· Two years of experience in Pre-Access, Patient Access, Admission or Hospital Business office preferred.
Â· An Associates Degree is preferred.
Â· College course or the equivalent in computer programs (Outlook, Word, Excel, Power Point) is encouraged.
Â· Some experience in a hospital Pre-registration or Registration area is preferred.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.