PATIENT ACCESS SPECIALIST

Aultman Health Foundation

Canton (OH)

On-site

USD 38,000 - 52,000

Full time

46 hours ago

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Job summary

Aultman Health Foundation is seeking a Patient Access Specialist to serve as the liaison between provider practices and patients for scheduling, referrals, and prior authorizations. You will help ensure timely access to diagnostic testing and specialty services while maintaining patient confidentiality and high-quality service.

You will verify insurance, manage referrals, and coordinate with physicians, laboratories, and imaging centers to support smooth workflow and optimal patient outcomes.

Qualifications

Minimum of one year of physician office experience.
Knowledge of medical terminology.
Knowledge of ICD-10 and CPT codes for authorizations.
Knowledge of insurance plans and their rules.

Responsibilities

Coordinate and process all patient referrals for diagnostic testing and specialty services.
Verify insurance eligibility and benefits; update patient information as needed.
Identify referral and authorization requirements from plans using online resources.
Prepare and document medical necessity for authorizations.
Enter referrals and authorizations into the system; track reports and follow‑ups.
Track patients not following through with referrals and document responses.
Inform patients about referral appointments and expectations.
Complete referrals and prior authorizations in a timely manner.
Communicate with patients, physicians, office staff, and manager to resolve issues.
Schedule patients per provider referral order; coordinate with facilities.
Assemble notes, labs, and send referrals to specialists; provide patients with letters and directions.
Ensure test orders are transmitted and orders are placed if missing.
Document referral information in patient chart; notify pre-authorizations when needed.
Demonstrate system knowledge and generate reports; manage referrals and authorizations.
Use electronic tools to organize daily work and report issues to supervision.
Assist Reimbursement Department to limit denials and ensure proper reimbursement.
Meet department deadlines and maintain confidentiality and safety practices.

Skills

Customer service

Verbal & written communication

Independent & prioritization

Staff relationships

Diversity & teamwork

Computer proficiency

Job description

Position Summary

The primary role of this position is to serve as liaison between the provider practices and patients in the process of scheduling, obtaining prior authorization for testing, diagnostic imaging, and referrals to other providers. The goal of the Patient Access team is to assure that these processes are managed effectively and efficiently in order to provide seamless and convenient access to specialized services deemed necessary by the patient and their provider to improve health outcomes and utilization of available services within the healthcare delivery system.

Job Description

Patient Access Specialist

Position Summary

Responsibilities And Expectations

Responsible for total coordination and processing of all patient referrals for diagnostic testing and specialty services.
Verifies insurance eligibility and benefits and updates the patient's insurance information as necessary.
Identifies the referral and authorization requirements of the patients' insurance plans by using various on-line resources according to department workflows.
Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized.
Enters all referral authorizations into the computer system. Maintain tracking of referral reports not received and timely follow-up in accordance with the office policy and procedures.
Maintain tracking of patients referred but not following through with a referral appointment and documenting patient response or lack of.
Reviews details and expectations about the referral appointment with the patients.
Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows.
Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.
Schedule patient as per provider referral order for diagnostic testing, therapy or specialist appointment at network facilities or specialty office.
For specialist referrals, assemble pertinent office notes, labs, testing, etc. and fax to specialist office and give patient referral letter with specialist name, location with directions if necessary, date and time of appointment.
For diagnostic testing patient will be advised of date, time and necessary test preparations. Check chart for test orders and make sure it has been faxed to the appropriate facility. If order is not present in chart, send note to provider to order the test in the chart and fax to appropriate facility.
A patient note containing referral information is sent to the primary referral coordinator for necessary insurance pre-authorizations and saved to chart when process is completed.
Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user’s security access.
Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work.
Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
Ensures that appropriate and accurate information is entered in the patient account.
Responds timely and collaborates effectively with the Reimbursement Department teams to limit denials and ensure proper reimbursement.
Exhibit excepted level of teamwork and respect. Collaborates with team members to meet department deadlines and benchmarks.
Anticipates and performs necessary job duties.
Maintains patient confidentiality
All special projects work, additional tasks, or other duties as assigned
Follow all Policies and Procedures
Meet/Exceed established quality and productivity expectations
Maintain attendance according to departmental standards
Complete safety evaluation, JCAHO education, Confidentiality, Information system usage, HIPAA corporate compliance education on an annual basis.

Job Requirements

Minimum of one (1) years of physician office experience.
Knowledge of medical terminology
Knowledge of ICD-10 and CPT codes for the purpose of authorizations
Knowledge of insurance plans and their rules

Skills

Excellent customer service skills
Effective verbal, written and listening communication skills
Ability to work independently, self-motivated, and prioritize.
Ability to establish and maintain effective working relationships with patients, medical staff, and co-workers
Ability to work with a diverse patient, physician and coworker population
Proficient computer skills – data entry, retrieval and report generation.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, identity, family status, gender, disability, or veteran status.

Working Conditions

8:00am - 5:00pm M-F or hours as required by the job.
May require occasional paid overtime.
Expected to adhere to office policy and procedures.
Subject to blood and body fluid exposure.
Subject to frequent interruptions and changes in priority of duties throughout the day.
Sitting/standing/moving about during working hours.
Spends time during the day using computers, telephones and printers.

Physical Requirements Addendum

PURPOSE: To identify specific functions job requirements and work environment factors that could affect job performance.

Check all factors that are present as essential job requirements and check whether the factor is performed.