Patient Access Representative II – Insurance Verification Representative

• 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

• 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

CHAA or related certification