Access Specialist
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Job Description
Access Specialist at Stella Mental Health ensuring patient access to mental health care by navigating insurance complexities. Completing verifications and authorizations for advanced treatments.
Responsibilities:
- Complete comprehensive Verification of Benefits, ensuring patients and internal teams have clear, accurate financial and coverage information.
- Initiate and manage Prior Authorizations for interventional services, ensuring timely submission and thorough follow-through.
- Proactively track authorization status and communicate updates to internal stakeholders.
- Challenge denials by initiating appeals, coordinating peer-to-peer reviews, and identifying alternative pathways to access care.
- Ensure patients experience minimal delays in starting treatment through persistent, proactive follow-up.
- Own end-to-end VOB and PA workflows, from intake to resolution, within defined turnaround times.
- Utilize internal systems including EMR (Athena/DrChrono), Salesforce, payer portals, and AI tools to complete and track work efficiently.
- Maintain accurate, up-to-date documentation across all systems to support visibility and reporting.
- Collaborate closely with Patient Care Coordinators, Treatment Coordinators, and clinic teams to ensure seamless patient access.
- Partner with Payor Relations and Clinical teams to escalate denials and resolve complex cases.
- Identify trends in denials, payer behavior, and workflow inefficiencies and escalate opportunities for improvement.
- Contribute to the development and refinement of standardized workflows, playbooks, and best practices.
Requirements:
- Experience in healthcare insurance workflows, including VOB and prior authorizations- minimum 2 years of experience
- Highly detail-oriented with strong organizational and follow-through skills.
- Persistent and solutions-oriented mindset- denials are challenges to be resolved, not endpoints.
- Comfortable navigating payer portals, insurance policies, and complex coverage scenarios.
- Strong written and verbal communication skills; ability to clearly document and relay information across teams.
- Technically proficient and adaptable, with experience using EMRs, CRMs (Salesforce), and digital tools.
Benefits:
- Health insurance
- Flexible work arrangements
- Professional development opportunities
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