Medical Office Specialist

Overview

The Medical Office Specialist is responsible for executing key front-end revenue cycle functions, including patient registration, insurance verification and authorization coordination. This position is integral to both patient care and provider support, ensuring efficient clinic operations, regulatory compliance, and high-quality service delivery, while working collaboratively with clinical and administrative teams to uphold departmental expectations, meet performance goals, and maintain compliance with performance goals/standards and HIPAA regulations.

Responsibilities

• Perform pre-registration and post-registration tasks, ensuring complete and accurate patient demographic and insurance information.

• Verify insurance eligibility and benefits using payer portals and internal systems.

• Initiate and manage prior authorizations for services, procedures, and referrals, including submission of medical necessity documentation.

• Track and follow up on pending authorizations to ensure timely approvals and prevent delays in care.

• Enter and maintain accurate records of registration, eligibility, and authorization activities in compliance with performance goals/standards, departmental protocols, and defined quality metrics (KPIs) related to front-end revenue cycle functions.

• Process all non-clinical orders placed by providers, including referrals, imaging, and specialist consults.

• Ensure all required documentation is complete and compliant with payer guidelines.

• Coordinate with external providers and facilities to facilitate timely and accurate referral fulfillment.

• Track referral status and turnaround times to support departmental performance goals.

• Maintain accurate logs and documentation to support compliance and reporting requirements.

• Educate patients on insurance coverage, co-pays, deductibles, and out-of-pocket responsibilities.

• Provide information on available payment plans, financial assistance programs, and departmental billing policies.

• Serve as a liaison between patients and billing staff to resolve financial inquiries and support payment arrangements.

• Document financial counseling interactions and patient decisions in accordance with compliance and quality standards.

• Answer and triage incoming calls using a multi-line phone system, ensuring prompt, courteous, and professional communication.

• Route calls appropriately to clinical or administrative staff based on patient needs.

• Provide accurate information regarding appointments, insurance, referrals, and financial services.

• Document call interactions and follow-up actions in the electronic health record (EHR) system.

• Monitor call queues and voicemail messages to ensure timely response and resolution.

• Track call metrics and contribute to performance improvement initiatives related to patient access and satisfaction.

• Perform other duties as assigned by the supervisors and/or Physicians.

Qualifications

Required: Computer literacy/proficiency, HIPAA regulations and patient confidentiality, ability to multitask in a fast paced environment, attention to detail, effective verbal and written communication, maintain professionalism under pressure, problem solving/critical thinking, and empathy.

Preferred: Computer literacy/proficiency in EHR platform EPIC, insurance platforms, and Microsoft Office; Knowledgeable in de-escalation techniques.

Location : Location