Pre Access Specialist

Full-time, 40 hours/week

Monday- Friday 8am-4:30pm

Remote- must be within commutable distance from Mahoning Valley location for 30-60 days onsite training

Summary:

Responsibilities:

1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.

2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.

3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.

4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.

5. Apply approved scripting for patient interactions and handle unique scenarios professionally.

6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.

7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.

8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.

9. Meet departmental standards for productivity, quality, and timeliness.

10. Other Duties as assigned

Other information:

Technical Expertise

1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits

2. Strong interpersonal communication skills to support families with empathy and clarity

3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred

4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)

5. Excellent communication, organizational, and time management skills

6. Ability to work independently in a fast-paced environment.

7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)

Education and Experience

1. High school diploma or equivalent required; associate degree or healthcare certification preferred.

2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.

3. Pediatric healthcare access roles preferred.

4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.

5. Experience in hospital admissions or emergency department settings preferred.

* Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.

Full Time

FTE: 1.000000

Status: Remote