Pt Access Rep II - Insurance Verification Rep

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:

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.