Patient Access Rep I – TMCOne -Insurance Verification Rep

SUMMARY:

The Patient Access Representative I – Insurance Verification is responsible for verifying insurance eligibility, securing authorizations, and ensuring accurate patient registration to support timely and complete reimbursement. This role serves as a key liaison between patients, providers, and payors, ensuring a seamless financial clearance process prior to service delivery.

ESSENTIAL FUNCTIONS:

·         Verify insurance eligibility and benefits using electronic tools and payer portals.

·         Obtain prior authorizations and document approvals in the registration system.

·         Collect co-pays, deductibles, and outstanding balances; establish payment plans when needed.

·         Explain insurance coverage, financial responsibility, and available financial assistance to patients.

·         Register patients accurately, ensuring all demographic and insurance data is complete.

·         Coordinate with clinical departments and physician offices to confirm procedure details and scheduling needs.

·         Respond to patient inquiries regarding insurance, billing, and scheduling.

·         Maintain accurate documentation of all verification and authorization activities.

·         Reconcile daily cash drawer and ensure compliance with financial policies.

·         Adhere to HIPAA and organizational confidentiality standards.

·         Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:

EXPERIENCE: One (1) year of experience in a healthcare setting preferred, especially in insurance verification or scheduling.

LICENSURE OR CERTIFICATION: None required.

KNOWLEDGE, SKILLS, AND ABILITIES:

·         Knowledge of insurance plans, medical terminology, and healthcare billing practices.

·         Strong communication and customer service skills.

·         Proficiency in EHR systems and payer verification tools.

·         Ability to multitask in a fast-paced environment.

·         Attention to detail and accuracy in data entry.

·         Basic computer and office equipment proficiency.