Access Specialist | Patient Access Representative

Access Specialist | Patient Access Representative

Join a compassionate healthcare team as a Patient Access Representative, where your role is vital in ensuring smooth patient intake and insurance verification processes. You will be responsible for identifying insurance coverage, obtaining necessary pre-certifications, and assisting with referral data entry to support positive patient and agency outcomes.

Essential Functions

• Verify insurance eligibility and benefits accurately.
• Obtain pre-certifications and ongoing authorizations from various insurance providers.
• Assist with intake and referral processes, ensuring timely responses to patient needs and optimal staffing utilization.
• Maintain up-to-date knowledge of federal, state, and private reimbursement regulations, including CMS and other regulatory bodies.
• Participate in insurance and regulatory audits and data submissions.
• Ensure compliance with certification, Plan of Care, and Face-to-Face requirements.
• Audit admissions and patient records for program-specific conditions and quality reporting.
• Complete pre-billing and performance improvement chart audits as assigned.
• Maintain accurate and timely documentation in accordance with agency policies.
• Foster effective communication and cooperation with physicians, staff, and clients to support reimbursement processes.
• Perform clerical duties such as managing phone calls and processing incoming faxes.
• Adhere strictly to HIPAA privacy and security regulations regarding Protected Health Information (PHI).

Minimum Knowledge and Skills

• Proficient computer skills with advanced knowledge of medical record systems.
• Effective communication abilities.
• Intermediate proficiency in Microsoft Office.
• Strong keyboarding, filing, and data processing skills.

Preferred Behavioral Skills

• Integrity: Demonstrates honesty and ethical behavior.
• Compassion: Shows empathy and excellent customer service.
• Accountability: Takes ownership and adapts to changing priorities.
• Respect: Collaborates well with diverse populations.
• Excellence: Communicates clearly and maintains high service standards.

Education and Experience

• Minimum: High School Diploma.
• Preferred: Medical Terminology knowledge, medical office experience, and insurance authorization experience.

Licenses and Certifications

• Required: Valid state driver's license and proof of auto liability insurance.
• Preferred: Associate's or Bachelor's Degree in Health Care or Business.

This position offers competitive pay and a generous benefits package within a supportive healthcare environment serving the Midwest region.