Provider Access Coordinator

Job Description

Job Description

Description:

The Provider Access Coordinator is responsible for supporting clinical operations and ensuring members are connected to high-quality, cost-effective, in-network providers and resources. This role facilitates access to care by coordinating incoming requests, verifying provider network status, and guiding members toward appropriate providers and services. The position also manages communications for Precertification, Case Management, and Care Navigation programs in alignment with Veracity Benefits policies and procedures.

Key Responsibilities

• Verify network status of providers and facilities and ensure members are directed to in-network options.
• Assist with single case agreements and direct pay contracts for out-of-network providers.
• Link members to quality, cost-effective, in-network providers and network resources based on their health needs.
• Assist with locating specialists and community resources for members.
• Coordinate access to providers, community resources, and health benefits as necessary.
• Receive and coordinate all incoming calls for distribution to the appropriate department or individual.
• Collect clinical information and set up cases for medical necessity review for precertification services.
• Communicate with providers regarding the status of precertification requests.
• Accurately document all case activities, including verbal and written communications, referrals, and resource identification.
• Engage clinical staff or supervisors for consultations when appropriate.
• Coordinate appeals when requested by clinical staff.
• Complete tasks and special projects as assigned.
• Assist with departmental reporting as required.
• Participate in company, departmental, and committee meetings.
• Provide feedback and input into program services, procedures, and resource needs.
• Maintain confidentiality in accordance with HIPAA.

• High School Diploma (required)
• Associate in Arts (AA)/Associate in Science (AS) degree or higher (preferred)
• Experience working in medical services background with knowledge of medical terminology
• Experience working in a managed care setting preferred
• Strong Problem-solving skills are essential
• Excellent typing, computer and documentation skills
• Knowledge of Microsoft Office products (Outlook, Word, Excel)
• Ability to coordinate and communicate with a multidisciplinary team (internal and external)
• Strong customer service