Patient Access Rep II - Insurance Verification Rep

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.

Responsibilities

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; Perform related duties as assigned

Requirements

Two (2) years of experience in a healthcare setting with a focus on insurance verification or patient access; 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

Nice to have

CHAA or related certification preferred