SUMMARY:
The Patient Access Representative II - Insurance Verification is responsible for advanced insurance verification, authorization coordination, and financial clearance functions. This role supports complex cases and serves as a resource for junior staff, ensuring accurate and timely processing of patient access workflows. The Representative II demonstrates a high level of proficiency in payer requirements, EHR systems, and patient communication.
ESSENTIAL FUNCTIONS:
- Verify insurance eligibility and benefits for complex and high-priority cases using payer portals and electronic tools.
- Obtain and document prior authorizations, including peer-to-peer requests and escalations.
- Coordinate with clinical departments and physician offices to ensure accurate procedure and diagnosis coding.
- Provide mentorship and training to Patient Access Representative I staff.
- Assist in resolving escalated patient inquiries and insurance issues.
- Ensure accurate and complete patient registration and financial documentation.
- Collect co-pays, deductibles, and outstanding balances; establish and monitor payment plans.
- Maintain compliance with HIPAA, organizational policies, and payer regulations.
- Participate in quality improvement initiatives and workflow optimization projects.
- Performs related duties as assigned.
MINIMUM QUALIFICATIONS
EDUCATION: High school diploma or GED required; vocational training in medical office administration preferred.
EXPERIENCE: Two (2) years of experience in a healthcare setting with a focus on insurance verification or patient access.
LICENSURE OR CERTIFICATION: None required; CHAA or related certification preferred.
KNOWLEDGE, SKILLS, AND ABILITIES:
- Advanced knowledge of insurance plans, medical terminology, and healthcare billing practices.
- Strong communication and customer service skills with the ability to de-escalate complex situations.
- Proficiency in EHR systems, payer verification tools, and Microsoft Office Suite.
- Ability to multitask, prioritize, and manage time effectively in a fast-paced environment.
- Attention to detail and accuracy in data entry and documentation.
- Demonstrated leadership and mentoring capabilities.