Tucson Medical Center
Pt Access Rep II - Insurance Verification Rep
Tucson Medical Center, Tucson, Arizona, United States, 85718
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.
: 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.