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.

Revenue Cycle Management

• Perform pre-registration and post-registration tasks, ensuring complete and accurate patient demographic and insurance information, to include verifying insurance eligibility/coverage and benefits using payer portals and internal system/platforms.

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

• Prompt follow up on internal communication to assigned pools or direct messaging, patient inquiries through EHR platform.

• Monitor and report on key performance indicators (KPIs) related to front end revenue cycle and patient quality metrics

Referral Processing

• Processing of all non-clinical orders placed by providers; this will include referrals to specialists, imaging, and procedures.

• Ensuring all necessary forms and/or medical information is documented/completed prior to submission of needed consultations, procedure, testing or specialist visits.

   

• Coordinate timely follow-up with patients, providers, and payers to ensure all care-related processes remain compliant with referred to provider and/or facility as well insurance guidelines and/or CMS regulations.

Financial Guidance

• 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.

Multi-Line Phone System Management

• 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.

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.