Join a dynamic healthcare team as an Access Specialist, where you will play a vital role in managing patient referrals and ensuring smooth clinical and financial processes. This full-time day position involves obtaining and verifying demographic, clinical, financial, and insurance information to facilitate patient care across various specialties.

Key Responsibilities

• Maintain comprehensive knowledge of referral processes, including internal and external referrals and protected patient information handling.
• Perform insurance eligibility and benefit verification using multiple systems, ensuring authorizations align with requested services.
• Validate medical necessity for Medicare and Non-Medicare cases to guarantee clinical and financial clearance.
• Obtain specialist contact details, print orders and patient demographics, and document accurately in electronic health records.
• Determine referral requirements and limitations, including emergent referrals, and pre-register patients for upcoming visits.
• Communicate referral approvals or denials to patients and guarantors, providing financial education as needed.
• Confirm appointments with referring offices and patients, following established protocols for reminders and preparation instructions.
• Complete follow-up procedures as directed by leadership to ensure timely referral processing.
• Collaborate with insurance companies, physicians, and hospital departments while adhering to HIPAA guidelines.
• Meet or exceed accuracy standards set by patient access leadership.

Education and Experience

• Registered or Certified Medical Office Assistant, or 2-4 years of direct referral experience in lieu of certification.
• Licensed Practical Nurse background is preferred.
• Medical terminology knowledge is required.
• 2-4 years of insurance/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 of employment.
• Strong knowledge of insurance processes and payment collection.
• Proficiency with Microsoft software.
• Excellent verbal and written communication, customer service, and problem-solving skills.
• Ability to manage complexity and stress in a fast-paced healthcare environment.
• Flexibility to work department hours, including possible shift rotations.

Physical Requirements

• Effective oral communication and ability to see and hear to collect information.
• Dexterity to operate office equipment and extensive use of computers and business machines.
• Ability to lift and move files and materials up to 50 pounds occasionally.
• Work environment noise level is low to moderate.

This role is based in a regional healthcare setting serving the Southeastern United States, offering a supportive and patient-centered work environment.