Patient Access Specialist (Insurance Verification & Scheduling)

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.