Job Description

Texas Regional Physicians is seeking a dependable, detail-oriented Patient Access Specialist to join our team. This position is responsible for verifying insurance eligibility and benefits, obtaining prior authorizations, coordinating referrals, scheduling patient appointments, and providing exceptional customer service throughout the patient experience.

The ideal candidate is organized, able to multitask in a fast-paced medical environment, and possesses a strong understanding of commercial insurance plans, Medicare, Medicaid, and prior authorization requirements.

Job Functions

• Verify patient demographics, insurance eligibility, and benefits prior to scheduled appointments.
• Obtain prior authorizations for procedures, imaging, injections, surgeries, and other services as required by insurance carriers.
• Review incoming referrals and process approvals in a timely manner.
• Verify CPT and ICD-10 diagnosis codes to ensure authorization accuracy.
• Communicate authorization approvals and denials to providers, scheduling staff, and referring offices.
• Contact patients to explain insurance benefits, deductibles, copays, coinsurance, and financial responsibility.
• Schedule and reschedule patient appointments while ensuring all insurance requirements have been met.
• Coordinate referrals with physicians, healthcare providers, and ancillary facilities.
• Confirm daily clinic appointments.
• Maintain accurate documentation within the Electronic Medical Record (EMR).
• Receive and coordinate telephone calls from patients, providers, and insurance companies.
• Maintain current provider and insurance information.
• Perform general administrative duties including answering phones, filing, faxing, scanning, and data entry.
• Complete daily reports and other tasks as assigned by management.
• Provide exceptional customer service to patients, providers, referring offices, and fellow team members.
• Perform additional duties as assigned by management.

Requirements

Education

• High School Diploma or GED required.
• Associate degree or healthcare administrative certification preferred.

Experience

• Minimum of 4-5 years of recent experience in insurance verification, benefits verification, prior authorizations, patient scheduling, medical billing, or a related healthcare administrative role.
• Experience working in a physician practice or multi-specialty clinic preferred.
• Experience using Electronic Medical Record (EMR) systems.
• Proficiency with Microsoft Office, email, and data entry.

Knowledge, Skills & Abilities

• Thorough understanding of commercial insurance plans, Medicare, Medicaid, PPO, and HMO plans.
• Knowledge of medical terminology, CPT coding, and ICD-10 diagnosis coding.
• Excellent customer service and interpersonal skills.
• Strong organizational skills with exceptional attention to detail.
• Ability to prioritize multiple tasks in a fast-paced environment.
• Ability to work independently and collaboratively as part of a team.
• Maintains strict HIPAA compliance and patient confidentiality.
• Ability to read, write, and communicate effectively in English.
• Bilingual (English/Spanish) required.

Texas Regional Physicians is an Equal Opportunity Employer.