Pre Access Specialist

Responsibilities

• 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.
• Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
• Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
• Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
• Apply approved scripting for patient interactions and handle unique scenarios professionally.
• Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
• Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
• Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
• Maintain departmental standards for productivity, quality, and timeliness.

Requirements

• Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
• Strong interpersonal communication skills to support families with empathy and clarity
• Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
• Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
• Excellent communication, organizational, and time management skills
• Ability to work independently in a fast-paced environment
• Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)

Qualifications

• High school diploma or equivalent required; associate degree or healthcare certification preferred.
• 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.
• Pediatric healthcare access roles preferred.
• Certification in healthcare access (e.g., CHAA or CMAA) preferred.
• Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.

Skills

• Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
• Strong interpersonal communication skills to support families with empathy and clarity
• Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
• Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
• Excellent communication, organizational, and time management skills
• Ability to work independently in a fast-paced environment
• Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)

Benefits

Our comprehensive benefits will help you thrive personally and professionally.