Patient Access Rep II – Insurance Verification Rep

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.

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.
• Coverage of procedures and diagnoses coding with clinical departments and physician offices.
• Mentor and train 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.

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.

Benefits

As an employee of TMC HealthCare, you will enjoy comprehensive benefits including health insurance, retirement plans, and paid time off.