Hybrid position, upon completion of on-the-job orientation. Seeking experience in healthcare patient access, insurance verification, billing, or related administrative support.

GENERAL SUMMARY:

Verifies patient insurance coverage and benefits and obtains required prior authorizations to ensure services are financially cleared before care is delivered. Coordinates with payers, provider offices, and internal teams to collect documentation, submit authorization requests, and meet established turnaround requirements. Communicates authorization outcomes, financial responsibility, and coverage limitations to patients and stakeholders. Supports revenue integrity and patient access through accurate documentation and timely followup.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

1. *Verifies insurance eligibility and benefits for scheduled services, admissions, referrals, and medications.

1. *Obtains required precertifications, referrals, and prior authorizations in accordance with payer guidelines.

1. *Collects and submits clinical documentation and supporting information to payers using phone, fax, and web-based portals, and/or Real Time Authorization (RTA) platforms.

1. *Documents authorization activity, approval details, dates, and payer communications in designated systems.

1. *Communicates authorization status, noncoverage notices, and next steps to patients and ordering offices.

1. *Coordinates with revenue cycle, billing, and utilization management teams to support claim readiness.

1. *Provides service estimates or connects patients to financial estimate resources as appropriate.

1. *Prioritizes urgent and emergent cases to meet defined turnaround expectations.

1. *Supports patient access workflows and performs additional department functions as assigned.

1. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

1. Participates in meetings, committees and department projects as assigned.

1. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of medical terminology and insurance processes.

1. Knowledge of computer hardware equipment and software applications relevant to work functions.

1. Ability to use healthcare information systems and standard office software.

1. Ability to communicate effectively both verbally and in writing.

1. Ability to perform crucial conversations with desired outcomes.

1. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

1. Ability to problem solve and engage independent critical thinking skills.

1. Ability to maintain confidentiality relevant to sensitive information.

1. Ability to prioritize work demands and work with minimal supervision.

1. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. Experience in healthcare patient access, insurance verification, billing, or related administrative support.