Job Details

Patient Access Rep II – Insurance Verification Rep Job CategoryClerical ScheduleFull time Shift1 - Day Shift

SUMMARY:

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:

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.