Patient Access Scheduler II

Patient Access Representative II Insurance Verification The shift is 8:30a.m. 5:00 p.m. Mon-Friday 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.