Patient Access Rep II – Insurance Verification Rep - TMC Rincon

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.
• Cook with accurate procedure and diagnosis coding.
• Provide mentorship and training to Patient Access Representative I staff.
• Aid 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.

Minimum Qualifications

• EDUCATION: Not specified
• 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.