Access Specialist | Certified Healthcare Access ...

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 verifying demographic, clinical, financial, and insurance information, as well as validating medical necessity for Medicare and Non-Medicare cases to guarantee proper clearance. 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 through LMRP/LCD reviews for various cases. Obtain and document specialist contact information, print orders, and update electronic health records accurately. Determine referral requirements and limitations, including emergent referrals. Pre-register patients for upcoming visits and communicate referral approvals or denials to patients and guarantors. Coordinate appointment confirmations and reminders with patients and referring offices. Complete follow-up protocols as directed by leadership for routine and urgent referrals. Assist insurance companies, physicians, and hospital departments with patient information in compliance with HIPAA. 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 as an alternative. 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 the Certified Healthcare Access Associate (CHAA) certification within one year of employment. Proficiency with Microsoft software. Excellent verbal and written communication, customer service, and problem-solving skills. Ability to manage complexity and stress while adapting to changing patient and organizational needs. Flexibility to work department hours, including possible shift rotations. Physical Requirements: Effective oral communication and sensory abilities to collect information. Dexterity to operate office equipment and perform filing tasks. Ability to lift or move weights up to 50 pounds occasionally. Work environment includes low to moderate noise levels and extensive computer use. This role is based in a regional healthcare setting serving the Southeastern United States, offering a supportive and patient-centered work environment.

Created: 2026-03-05