Patient Access Representative - Outpatient Services

Job Description

Job Description

Description:

Job Title: Patient Access Representative – Outpatient Services

Company: Physician Care Coordination Consultants (PC3)

Location: Remote

Job Type: Full-time

Job Classification:

This is a non-exempt position under the Fair Labor Standards Act (FLSA) and is eligible for overtime pay for hours worked over 40 in a workweek, in accordance with applicable federal, state, and local laws.

Our Mission:

Our mission is to drive financial wellness in healthcare organizations so more patients can receive the care they need. 

Our Vision:

Our vision is a future where we help healthcare organizations thrive in a complex ecosystem by clearing a path to financial health. 

Our Culture:

We are committed to creating a workplace where every member feels valued, empowered, and inspired to contribute their best. Together we will foster a culture that promotes work-life balance and celebrates community engagement, personal achievements, milestones, and special occasions. 

Values:

• Integrity – We do what’s right, no matter what. 
• Innovation – We use a harmonious blend of data, tech, and a human-centric approach. 
• Compassion – We understand the stress of healthcare organizations and their patients.
• Determination – Our mission is our guiding force. 
• Partnership – We build enduring relationships through listening, communication and accountability. 
• Dignity – We have significant pride in each other and our work. 

Job Summary:

The Patient Access Representative is responsible for supporting outpatient service lines through accurate patient registration, insurance verification, schedule review, medical record requests, and customer service. This role serves as a critical link between patients, providers, payors, and clinical departments to ensure timely access to care, accurate reimbursement, and exceptional patient experience.

The Patient Access Representative works proactively to verify insurance eligibility and coverage, review departmental schedules, and resolve registration or coverage issues before the patient's appointment as well as working with provider offices to obtain the necessary clinical documentation to support medical necessity for prior authorizations and appeals.  

This position reports directly to the Associate Director of Revenue Cycle Management.

Supervisory Responsibilities:

This position has no direct supervisory responsibilities.  

Duties/Responsibilities:

• Verify patient insurance eligibility, benefits, and coverage prior to scheduled services.
• Review coverage requirements for outpatient procedures, diagnostic testing, infusion services, specialty clinics, and other outpatient departments.
• Confirm that all active insurance policies are accurately documented within registration and billing systems.
• Identify primary, secondary, and tertiary coverage and verify coordination of benefits when applicable.
• Ensure that accurate insurance information is available to support the submission and processing of required authorizations by designated departments.
• Review insurance records for discrepancies and proactively resolve coverage issues before the date of service.
• Communicate coverage information and potential insurance concerns to patients and appropriate clinical or revenue cycle teams.
• Maintain detailed documentation of verification activities within the electronic medical record (EMR) and scheduling systems.
• Escalate complex insurance eligibility and coverage issues to leadership or financial counseling teams when appropriate.
• Review daily outpatient department schedules to identify newly scheduled patients, add-on appointments, and schedule changes requiring insurance verification.
• Prioritize verification activities for new patient appointments and add-on cases to ensure coverage is validated before services are rendered.
• Monitor department schedules throughout the day for appointment additions, cancellations, reschedules, and provider schedule changes.
• Collaborate with clinical, scheduling, and registration teams to ensure newly scheduled patients are reviewed promptly and all required insurance information is obtained.
• Identify patients with incomplete, missing, or outdated insurance information and take appropriate action to obtain accurate coverage details.
• Ensure insurance verification activities are completed within established departmental timelines to support patient access and operational efficiency.
• Communicate coverage concerns, eligibility issues, or missing insurance information to appropriate staff to prevent delays in patient care.
• Maintain accurate documentation of verification activities and schedule reviews within the electronic medical record (EMR) and scheduling systems.
• Support departmental workflow by providing timely review of schedule additions and changes, helping ensure patients are financially and administratively cleared prior to service.
• Work closely with outpatient departments to manage high-volume scheduling activity and respond efficiently to same-day or urgent add-on appointments.
• Assist in identifying scheduling trends or workflow opportunities that may improve insurance verification turnaround times and overall patient access. 
• Work closely with Appeals Nurses, coders, and revenue cycle specialists to identify the appropriate medical records to request from providers. 
• Timely and accurately presenting medical record requests to provider offices.
• Obtaining medical records from providers
• Other duties as assigned.

Knowledge/Skills/Abilities:

• Thorough understanding of insurance eligibility, coverage verification, and coordination of benefits.
• Knowledge of outpatient scheduling workflows and department operations.
• Understanding of how accurate insurance verification supports successful authorization and billing outcomes.
• Strong organizational and time management skills.
• Attention to detail and accuracy in data entry and documentation.
• Ability to maintain confidentiality and comply with HIPAA regulations.
• Strong problem-solving and conflict-resolution skills.
• Ability to work independently and collaboratively with clinical and administrative teams
• Strong customer service and communication skills. 
• Ability to manage multiple priorities in a fast-paced healthcare environment.
• Proficiency in Microsoft Office applications.

Education and Experience:

• High School Diploma or GED required.
• Minimum of 1–2 years of healthcare registration, scheduling, insurance verification, or revenue cycle experience preferred.
• Knowledge of commercial insurance, Medicare, Medicaid, managed care plans, and coordination of benefits.
• Experience working with electronic medical records and scheduling systems.

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Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.