Patient Access Rep II Insurance Verification Rep - TMC Rincon ASC

Patient Access Representative II Insurance Verification

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.