POSITION SUMMARY

The Lead Clinical Access Specialist oversees a team of Access Specialists and manages all aspects of the referrals that come from hospitals, physicians, facilities, and individuals for Blue Ridge Care’s service lines. The Lead Clinical Access Specialist also ensures the scheduling of the initial visits, informational visits, and referrals are timely and for the appropriate service line. The Lead Clinical Access Specialist assures compliance with federal, state, and local laws and regulations as well as The Joint Commission standards and the organization’s policies and procedures. The role supports a seamless transition from referral to admission by verifying hospice eligibility, reviewing clinical documentation, collaborating with the appropriate teams and team members, and adhering to the Perfect Phone Encounter structure.

EDUCATION AND EXPERIENCE

• Registered Nurse preferred; Licensed Practical Nurse (LPN) required.
• Must have reliable transportation and a valid driver’s license.
• Strong public relations and interpersonal skills, with a professional telephone manner.
• Highly organized, flexible, and detail oriented.
• Proficient computer skills required; experience with Excel, Microsoft Office, and electronic medical records preferred.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Possesses interpersonal skills that promote collaboration and effective communication.
• Demonstrates working proficiency in Medicare, Medicaid, and other payor operations, in collaboration with the billing department, to support accounts receivable management.
• Conducts insurance verification and coordinates benefits for referrals to Blue Ridge Care service lines, with the business office serving as backup.
• Demonstrates strong data collection and analysis skills.
• Act independently and responsibly in consistently performing job duties.
• Exhibits a team-oriented mindset, flexibility, willingness to learn, strong interpersonal skills, and a customer service orientation.
• Demonstrates a commitment to delivering high-quality patient care.
• Assists in communication with patients, referral sources, and external providers.
• Prioritize patient needs by triaging based on acuity to ensure timely access for critical patients.
• Collaborates with providers regarding patient eligibility per Medicare guidelines and coordinates appropriate Face to Face assessments with providers.
• Arranges necessary medical supplies for patients transitioning from hospital or skilled services to ensure availability at the time of admission.
• Assist providers in obtaining infusion medications from pharmacies before admission.
• Serves as a resource for intake staff, offering guidance on diagnoses and treatments that require provider review prior to scheduling an admission.
• Provides administrative supervision to Access Center administrative volunteers.
• Respects the autonomy and confidentiality rights of all patients.
• Willing to travel throughout the entire service area.
• Seeks opportunities for professional growth, including demonstrating the ability to receive and apply constructive performance feedback. Engage supervisors or other resources to address areas for improvement.
• Participate in departmental and/or agency-wide quality improvement activities.
• Supports and upholds the mission of Blue Ridge Care.
• Performs other duties as assigned.

LEAD CLINICAL ACCESS SPECIALIST RESPONSIBILITIES

• Supports the Blue Ridge Perfect Phone Encounter structure.
• Collects data and documentation to assist in validating palliative and hospice eligibility.
• Facilitates a smooth transition from referral to admission when eligibility criteria are met.
• Verifies that all documentation required for admission, including insurance verification, is complete.
• Maintains clear and timely communication with all appropriate team members.
• Demonstrates proficiency in the Perfect Phone Encounter and communicates effectively with patients, families, physicians, referral sources, and staff.
• Completes benefit checks through the approved CMS website to verify coverage and obtain pre-authorization for services as needed.
• Initiates the Electronic Medical Record (EMR) at the time of referral by entering patient information and ensuring all necessary documentation is completed.
• Schedules for providers and other team members as appropriate.
• Assists with retrieving medical records and ensures all required documents are complete for admission.
• Files and maintains medical records in accordance with company policy and state/federal regulations.
• Assist in data collection and evaluation for quality outcomes and patient experience.