Patient Access Representative - Authorizations

Authorizations-Patient Access Rep I

We are seeking a highly organized and detail-oriented Insurance Verification Representative to join our team. The successful candidate will be responsible for verifying insurance data, ensuring eligibility and benefits, and facilitating accurate billing. Additionally, this role involves coordinating with insurance companies for prior authorizations, preparing cost estimates, collecting payments at the time of service, and submitting medical records for clinical reviews. The ideal candidate will have strong communication skills, a keen eye for detail, and a deep understanding of insurance verification processes.

Key Responsibilities:

• Verify insurance benefits and eligibility to ensure accurate billing and claims submission.
• Contact insurance companies to obtain prior authorizations for medical procedures and surgeries before patient visits.
• Review and prepare cost estimates to ensure accurate collections at the time of service.
• Send requested medical records to insurance companies for clinical reviews, ensuring compliance with all privacy and regulatory standards.
• Coordinate with healthcare providers to resolve any insurance-related issues and ensure timely claim processing.
• Maintain up-to-date knowledge of insurance plans, billing guidelines, and procedures to ensure accurate and compliant practices.
• Track and follow up on outstanding authorizations, benefits verification, and other insurance-related inquiries to ensure the timely resolution of issues.
• Contact patients to provide estimates as needed
• Communicate effectively with patients, insurance representatives, and internal staff to resolve billing or authorization issues promptly.
• Assist with any other duties related to insurance verification, scheduling and billing as needed.

Qualifications

Education: High School Diploma or GED equivalent

Experience: 2 years in hospital insurance verification and scheduling preferred.