Patient Access Representative

Job description

The Patient Access Specialist performs front-end patient access activities to ensure accurate and complete eligibility verification, insurance information, and scheduling support. This role collaborates with the Patient Access Supervisor and other Revenue Cycle teammates to verify coverage, obtain pre-authorizations or referrals as required, update payer information, and communicate any insurance concerns to patients. The Specialist supports timely patient scheduling and contributes to minimizing appointment delays and revenue cycle bottlenecks. Key Responsibilities: · Perform pre-visit eligibility verification and insurance validation for upcoming appointments using payer portals and internal systems. · Confirm current benefits, coverage, network status, and effective dates; identify potential coverage gaps or pre-authorization/referral requirements. · Obtain and document necessary authorizations, referrals, or pre-certifications as required by payer policies and practice guidelines. · Notify patients of potential insurance issues (e.g., uncovered services, out-of-pocket estimates, authorization needs) and coordinate next steps with scheduling and financial counseling. · Update and maintain accurate patient and insurance information across multiple systems (EMR, scheduling, and billing platforms) to ensure correct pre-authorization, billing, and eligibility data. · Communicate clearly with patients regarding verification outcomes, next steps, and any required financial responsibilities. · Collaborate with scheduling, clinical staff, and payors to resolve insurance-related scheduling barriers and ensure timely care. · Escalate complex or unresolved issues to the Patient Access Supervisor with recommended remediation plans. · Maintain compliance with HIPAA and privacy/security requirements in all interactions and data handling. · Document interactions and outcomes in the EMR and relevant systems; maintain accurate, auditable notes. · Participate in process improvement initiatives to streamline intake workflows, improve eligibility capture, and reduce pre-visit denials. Required Qualifications: · High school diploma or equivalent; associate degree or related certifications preferred (e.g., CHAA, CPC, CPAR, or revenue cycle certification). · Experience in patient access, eligibility verification, scheduling support, or front-end Revenue Cycle activities, preferably in dermatology or outpatient settings. · Familiarity with payer enrollment and pre-authorization workflows; ability to interpret basic EOBs and coverage data. · Proficient with EMR systems and payer portals; comfortable navigating multiple systems to extract and update information. · Strong communication skills with the ability to explain insurance concepts clearly to patients. · Knowledge of HIPAA requirements and commitment to patient privacy and data security. · Ability to collaborate effectively with front desk staff, clinicians, and Revenue Cycle colleagues. · Detail-oriented with strong organizational and time-management skills. Preferred Qualifications: · Experience with dermatology or cosmetic dermatology services. · Bilingual abilities (e.g., English/Spanish) to support a diverse patient population. Compensation: $70,000 per year New York City's Largest Dermatology Practice We're a full-service dermatology practice with 50+ locations across Manhattan, Brooklyn, Queens and Long Island. Now Delaware and Philly too!