This position plays a key role in supporting patient access to care by verifying insurance eligibility, benefits, and securing necessary authorizations and referrals prior to scheduled services. Working remotely within the Tri-County Area, the representative ensures timely financial clearance across multiple clinic settings, contributing to efficient patient scheduling and reduced administrative delays.
Key Responsibilities
- Verify insurance eligibility and benefits using real-time tools, online portals, phone systems, and electronic health records
- Accurately update and validate insurance details in the patient management system, including guarantor accounts, policy numbers, and claims addresses
- Generate and document referrals and preauthorizations, noting coverage terms such as deductibles and co-insurance
- Obtain approvals from primary care providers and health plans in compliance with contractual guidelines
- Submit required documentation for authorization processing and record approvals in the system
- Communicate with patients, providers, and internal teams regarding insurance requirements, denials, or follow-up needs
- Maintain productivity benchmarks, quality accuracy above 95%, and keep work queues updated within a 14-day window
- Support patient education on insurance processes and financial responsibilities
- Collaborate with Patient Access and clinical departments to resolve issues and improve workflows
- Participate in service recovery efforts and escalate complex cases as needed
- Engage in continuous process improvement initiatives
Qualifications
A High School Diploma or equivalent is required, along with at least one year of relevant experience in insurance verification or patient registration. Proficiency with electronic health record systems—particularly EPIC applications—is strongly preferred. Candidates must demonstrate strong communication skills, composure under pressure, and the ability to work effectively in a team-oriented environment.
Bilingual abilities and prior experience with insurance authorizations, referrals, and healthcare navigation are considered advantages. The ideal candidate is detail-oriented, resourceful, and committed to delivering accurate, compassionate service to patients of diverse backgrounds.
Work Environment
This is a remote position open to candidates in the Tri-County Area. The role operates in a fast-paced, high-pressure setting requiring strong organizational skills and consistent attention to deadlines and compliance standards.
Compensation and Benefits
The position offers a competitive salary and a comprehensive benefits package, including medical and dental coverage. Employees also enjoy tuition remission and other institutional benefits.
Organizational Context
The healthcare system is recognized for excellence in teaching, research, and patient care, serving communities across South Florida, Latin America, and the Caribbean. As an Equal Opportunity Employer, it fosters innovation and values diversity, inclusion, and proactive problem-solving across all levels of operation.
