MLee Healthcare Staffing and Recruiting, Inc
Access Associate | Certified Healthcare Referral Specialist
MLee Healthcare Staffing and Recruiting, Inc, Goldsboro, North Carolina, us, 27533
Join a dynamic healthcare team as a Referral Specialist, where you will play a vital role in coordinating 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.
Key Responsibilities:
Maintain comprehensive knowledge of medical administrative procedures, including internal and external referrals and protected patient information handling. Perform insurance eligibility and benefit verification using multiple systems, ensuring authorizations align with requested services. Validate medical necessity through LMRP/LCD reviews for various cases. Obtain and document specialist contact details, print orders, and update electronic health records accurately. 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. Collaborate with insurance companies, physicians, and hospital departments while adhering to HIPAA guidelines. Meet or exceed accuracy standards set by leadership and perform other duties as assigned. Education and Experience:
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. Skills and Abilities:
Successful completion of pre-employment and post-training testing. Pass and maintain Certified Healthcare Access Associate (CHAA) certification within one year. Strong knowledge of insurance processes and payment collections. Proficiency with Microsoft software. Excellent verbal and written communication, customer service, and problem-solving skills. Ability to manage complexity and stress while adapting to patient and organizational needs. Flexibility to work variable shifts and department hours. Physical Requirements:
Effective oral communication and sensory abilities to collect information. Manual dexterity to operate office equipment. Ability to handle moderate noise levels and extensive computer use. Capability to lift or move weights up to 50 pounds occasionally.
This role is based in a regional healthcare setting serving the Southeastern United States, offering a supportive environment focused on patient-centered care and operational excellence.
Key Responsibilities:
Maintain comprehensive knowledge of medical administrative procedures, including internal and external referrals and protected patient information handling. Perform insurance eligibility and benefit verification using multiple systems, ensuring authorizations align with requested services. Validate medical necessity through LMRP/LCD reviews for various cases. Obtain and document specialist contact details, print orders, and update electronic health records accurately. 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. Collaborate with insurance companies, physicians, and hospital departments while adhering to HIPAA guidelines. Meet or exceed accuracy standards set by leadership and perform other duties as assigned. Education and Experience:
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. Skills and Abilities:
Successful completion of pre-employment and post-training testing. Pass and maintain Certified Healthcare Access Associate (CHAA) certification within one year. Strong knowledge of insurance processes and payment collections. Proficiency with Microsoft software. Excellent verbal and written communication, customer service, and problem-solving skills. Ability to manage complexity and stress while adapting to patient and organizational needs. Flexibility to work variable shifts and department hours. Physical Requirements:
Effective oral communication and sensory abilities to collect information. Manual dexterity to operate office equipment. Ability to handle moderate noise levels and extensive computer use. Capability to lift or move weights up to 50 pounds occasionally.
This role is based in a regional healthcare setting serving the Southeastern United States, offering a supportive environment focused on patient-centered care and operational excellence.