Join a dedicated healthcare team as an Access Specialist, where you will play a vital role in managing patient referrals and ensuring smooth clinical and financial clearance. This full-time, daytime position involves verifying demographic, clinical, financial, and insurance information, as well as validating medical necessity for Medicare and non-Medicare cases. You will coordinate physician orders and referrals, conduct insurance eligibility and benefit verification, and provide pre-certification and financial education to patients.

Key Responsibilities

• Maintain comprehensive knowledge of referral processes and medical administrative procedures.
• Perform insurance eligibility and benefit verification using various tools, ensuring authorizations align with requested services.
• Validate medical necessity for services, procedures, and referrals to guarantee clinical and financial clearance.
• Obtain and document specialist contact information and patient data accurately in electronic health records.
• Determine referral requirements and limitations, including emergent referrals.
• Pre-register patients for upcoming visits and communicate appointment details to patients and referring offices.
• Provide follow-up on referrals according to established protocols and timelines.
• Assist insurance companies, physicians, and hospital departments with patient information in compliance with privacy regulations.
• Meet or exceed accuracy standards set by leadership.

Education and Experience

• Registered or Certified Medical Office Assistant, or 2-4 years of direct referral experience as an alternative.
• Licensed Practical Nurse background is preferred.
• Medical terminology knowledge is required.
• 2-4 years of insurance or referral experience in a hospital or medical office setting is preferred.

Skills and Abilities

• Successful completion of pre-employment and post-training testing.
• Pass and maintain Certified Healthcare Access Associate (CHAA) certification within one year.
• Strong knowledge of insurance processes and payment collections.
• Proficiency with Microsoft software.
• Excellent verbal and written communication, customer service, and problem-solving skills.
• Ability to manage complexity and stress in a dynamic healthcare environment.
• Flexibility to work department hours and rotate shifts as needed.

Physical Requirements

• Effective oral communication and sensory abilities to collect information.
• Dexterity to operate office equipment and extensive computer use.
• Ability to lift and move items up to 50 pounds occasionally.
• Work in a low to moderate noise environment.

This role offers an opportunity to contribute to a regional healthcare network serving the Southeastern United States, providing compassionate and efficient access services to patients and providers alike.