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 insu...