Patient Access Representative

Key Responsibilities

• Perform pre-visit eligibility verification and insurance validation for upcoming appointments using payer portals and internal systems.
• Confirm current benefits, coverage, network status, and effective dates; identify potential coverage gaps or pre-authorization/referral requirements.
• Obtain and document necessary authorizations, referrals, or pre-certifications as required by payer policies and practice guidelines.
• Notify patients of potential insurance issues (e.g., uncovered services, out-of-pocket estimates, authorization needs) and coordinate next steps with scheduling and financial counseling.
• Update and maintain accurate patient and insurance information across multiple systems (EMR, scheduling, and billing platforms) to ensure correct pre-authorization, billing, and eligibility data.
• Communicate clearly with patients regarding verification outcomes, next steps, and any required financial responsibilities.
• Collaborate with scheduling, clinical staff, and payors to resolve insurance-related scheduling barriers and ensure timely care.
• Escalate complex or unresolved issues to the Patient Access Supervisor with recommended remediation plans.
• Maintain compliance with HIPAA and privacy/security requirements in all interactions and data handling.
• Document interactions and outcomes in the EMR and relevant systems; maintain accurate, auditable notes.
• Participate in process improvement initiatives to streamline intake workflows, improve eligibility capture, and reduce pre-visit denials.

Required Qualifications

• High school diploma or equivalent; associate degree or related certifications preferred (e.g., CHAA, CPC, CPAR, or revenue cycle certification).
• Experience in patient access, eligibility verification, scheduling support, or front-end Revenue Cycle activities, preferably in dermatology or outpatient settings.
• Familiarity with payer enrollment and pre-authorization workflows; ability to interpret basic EOBs and coverage data.
• Proficient with EMR systems and payer portals; comfortable navigating multiple systems to extract and update information.
• Strong communication skills with the ability to explain insurance concepts clearly to patients.
• Knowledge of HIPAA requirements and commitment to patient privacy and data security.
• Able to collaborate effectively with front desk staff, clinicians, and Revenue Cycle colleagues.
• Detail-oriented with strong organizational and time-management skills.

Preferred Qualifications

• Experience with dermatology or cosmetic dermatology services.
• Bilingual abilities (e.g., English/Spanish) to support a diverse patient population.

Compensation

$70,000 per year

Corporate Location

Long Island City, NY