Access Specialist | Certified Healthcare Access Associate (CHAA)

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 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 for services.

• Maintain comprehensive knowledge of medical administrative procedures, including internal and external referrals and protected patient information handling.
• Perform insurance eligibility and benefit verification using various tools, ensuring authorizations align with requested tests or specialties.
• Validate medical necessity through LMRP/LCD reviews to secure 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.
• 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.
• Follow up on referrals according to established protocols and timelines.
• Assist insurance companies, physicians, and hospital departments with patient information in compliance with HIPAA.
• Meet or exceed accuracy standards set by leadership.

• 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.

• Successful completion of pre-employment and post-training testing.
• Pass and maintain the Certified Healthcare Access Associate (CHAA) certification within one year.
• 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 variable shifts as required.

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