Outpatient Access Specialist

Description

Job Summary

The Outpatient Access Specialist serves as the centralized intake and scheduling point of contact for all Outpatient Services referrals, including but not limited to lab, radiology, wound care, treatment room, and endoscopy services. This role receives and processes physician orders, verifies insurance benefits and prior authorization, schedules patients, routes referrals to the appropriate outpatient service line, and serves as the department's primary point of contact for patients regarding scheduling, payment, and account questions. No degree is required for this position; relevant scheduling, registration, or insurance/billing experience is required.

Essential Duties and Responsibilities

• Receives incoming physician orders/referrals for all Outpatient Services lines and scans/enters them into the appropriate system.
• Serves as keeper of the department tracking board, ensuring referrals and orders are logged and monitored through to scheduling.
• Communicates and coordinates with ancillary departments (lab, radiology, wound care, endoscopy, etc.) to route referrals appropriately.
• Contacts patients to schedule appointments for ordered outpatient services.
• Verifies insurance benefits and eligibility prior to scheduling.
• Confirms that ordered diagnoses support and justify the requested service (diagnosis/medical necessity check).
• Verifies that prior authorization has been obtained for orders originating from internal/credentialed providers, or that authorization documentation has been received and recorded for orders from outside/non-credentialed providers.
• Identifies orders with conflicts, missing information, or clarification needs and routes them to the Outpatient Services Technician for order clarification.
• Discusses cost, payment plans, and insurance/billing questions with patients as needed.
• Maintains a clean, organized, and welcoming intake/scheduling work area.
• Cross-trains with the Outpatient Services Technician role to provide backup coverage as needed.
• Performs other duties as assigned to support Outpatient Services operations.

Requirements

Qualifications

Education

• High school diploma or equivalent required. No specific degree required.

Experience

• Relevant experience in patient scheduling, registration, medical office intake, or insurance verification/billing required.
• Experience with electronic health records/practice management systems preferred.

Knowledge, Skills, and Abilities

• Strong organizational skills and attention to detail, particularly in tracking referrals and orders to completion.
• Working knowledge of insurance verification, prior authorization processes, and basic medical necessity/diagnosis requirements.
• Strong written and verbal communication skills, including comfort discussing payment and insurance matters with patients.
• Ability to multitask and manage a high volume of incoming referrals across multiple service lines.
• Customer service orientation and professionalism in all patient interactions.
• Ability to work collaboratively with clinical staff to resolve order or scheduling conflicts.

Working Conditions / Physical Requirements

Work is performed primarily in an office/front-desk setting within Outpatient Services. Requires prolonged periods of sitting, telephone and computer use, and the ability to manage frequent interruptions and a high volume of referrals. Hours align with Outpatient Services operating hours with scheduling as assigned.