Patient Access Specialist

Job Description

Job Description

Position Summary:

The Patient Access Specialist (PAS) completes core Patient Access functions from initial intake through completion of assigned patient accounts, including fax triage, entry of patient and insurance information, eligibility and benefit verification, prior authorization initiation and follow-up, resolution of missing information, and accurate account documentation. The PAS maintains ownership of assigned accounts and ensures required activities are completed accurately and within established turnaround times. This role collaborates closely with Patient Access, Revenue Cycle Management (RCM), Clinical Services, patients, referring offices, health plans, and other stakeholders.

Job Responsibilities:

* Retrieve, review, and triage incoming faxes and other correspondence as part of the initial intake process; identify request type, urgency, required action, and missing information.

* Accurately enter and maintain patient demographics, insurance information, referring provider information, and other required data within Salesforce and designated systems.

* Prioritize STAT, urgent, and time-sensitive requests according to established procedures and assume ownership of assigned accounts through completion.

* Verify patient eligibility and insurance coverage using Waystar, payer portals, direct payer communication, and other authorized resources.

* Complete benefit verifications accurately and within established turnaround times, including review of applicable commercial and government insurance benefits, secondary coverage, and coordination of benefits when applicable.

* Determine whether prior authorization, referral, GAP exception, or other payer approval is required; initiate and submit requests with accurate supporting information.

* Complete routine follow-up on pending authorizations, respond to payer requests for additional information, and accurately document authorization status, reference numbers, effective dates, payer communication, and determinations.

* Escalate complex, delayed, or unresolved authorization or benefit matters according to established escalation procedures.

* Review accounts for missing documentation or information and proactively work toward resolution while maintaining complete and accurate account statuses and notes.

* Ensure completed accounts contain the information necessary to support downstream Revenue Cycle processes.

* Communicate professionally with patients, referring offices, health plans, Clinical Services, RCM, and other stakeholders; provide timely account status updates and proactively communicate barriers or delays.

* Meet established departmental expectations for accuracy, productivity, quality, and turnaround time; participate in quality reviews, coaching, training, and process improvement initiatives.

* Maintain compliance with HIPAA, applicable regulations, payer requirements, and CND policies.

* Perform other duties as assigned.

Requirments:

* 1+ years of experience in healthcare patient access, benefit verification, prior authorization, or revenue cycle management. Laboratory experience preferred but not required.

* Proficiency with Salesforce, Waystar, payer portals, and laboratory billing platforms.

* Working knowledge of commercial and government insurance coverage.

* Familiarity with medical insurance eligibility, benefits, prior authorization, and medical terminology.

* Strong attention to detail, organization, time-management, problem-solving, and customer service skills.

* Ability to manage multiple accounts and competing priorities in a fast-paced, remote, collaborative environment.

* Professional verbal and written communication skills.

Education:

* High school diploma or general education degree required.

* Related coursework or education (e.g., billing certificate, associate's degree, or bachelor's degree) with a focus on billing or related field preferred.

#MedixLS

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\rOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?