Patient Access Representative

Patient Access Representative II – Insurance VerificationThe 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.