Job Details

Join a compassionate healthcare team in the Midwest region as a Patient Access Representative, where your role is vital in ensuring smooth patient intake and insurance verification processes. You will be responsible for identifying insurance coverage, obtaining necessary pre-certifications, and assisting with referral data entry to support positive patient and agency outcomes.

Essential Functions

• Verify insurance eligibility and benefits accurately.
• Obtain pre-certifications and ongoing authorizations from various insurance providers.
• Assist with intake and referral processes, ensuring timely responses to patient needs and optimal staffing utilization.
• Maintain up-to-date knowledge of federal, state, and private reimbursement regulations, including CMS guidelines.
• Participate in insurance and regulatory audits and data submissions.
• Facilitate compliance with certification, PPOC, and Face to Face requirements.
• Audit admissions and patient records for program-specific conditions and quality reporting.
• Complete pre-billing and performance improvement chart audits as assigned.
• Document accurately and timely according to agency policies.
• Promote effective communication and cooperation with physicians, staff, and clients to ensure reimbursement success.
• Support billing processes including generation and transmission of notices of election and admission.
• Perform clerical duties such as managing phone calls and processing incoming faxes.
• Adhere strictly to HIPAA privacy and security regulations regarding Protected Health Information (PHI).

Minimum Knowledge and Skills

• Advanced computer skills with proficiency in medical record systems.
• Effective communication abilities.
• Intermediate knowledge of Microsoft Office suite.
• Strong keyboarding, filing, data processing, and general office skills.

Preferred Behavioral Skills

• Integrity: Demonstrates honesty and a commitment to ethical behavior.
• Compassion: Exhibits empathy and excellent customer service.
• Accountability: Takes ownership of projects and adapts flexibly to changing priorities.
• Respect: Collaborates effectively with diverse populations and maintains a positive service orientation.
• Excellence: Communicates clearly and upholds high standards in service delivery.

Education and Experience

• Minimum: High School Diploma.
• Preferred: Associate's or Bachelor's Degree in Health Care or Business.
• Preferred experience includes medical terminology, medical office work, and insurance authorization.

Licenses and Certifications

• Required: Valid driver's license and proof of auto liability insurance.

This role offers competitive pay and a generous benefits package, providing a meaningful opportunity to contribute to quality patient care in a supportive environment.