PATIENT SERVICES REPRESENTATIVE - (Authorizations, Verification & Referrals)

SUMMARY/OBJECTIVE:

The Patient Services Representative provides support for patients, providers, and patient services departments. The representative will assist with and be responsible for duties that include, but not limited to, insurance verification, prior authorizations for procedures and medications, coordinating incoming and outgoing referrals. Please note that this position is 100% on-site in our central support office in Plano. 

Essential Functions:

• Verify patient insurance eligibility and benefits for Psychiatry, Neurology, and Primary Care services using electronic eligibility systems and direct communication with insurance carriers. 
• Obtain and manage prior authorizations for procedures, diagnostic services, and medications, including submitting requests, monitoring status, and coordinating appeals when necessary. 
• Coordinate incoming and outgoing patient referrals with internal providers and external healthcare organizations to support continuity of patient care. 
• Research, identify, and resolve insurance, billing, payment, and authorization issues to facilitate timely reimbursement. 
• Request, receive, process, and securely transmit patient medical records in accordance with HIPAA, company policies, and regulatory requirements. 
• Receive, distribute, and process incoming correspondence, including electronic and faxed documentation, ensuring timely routing to appropriate departments. 
• Respond professionally to inquiries from patients, insurance companies, providers, and internal staff regarding insurance coverage, billing, referrals, authorizations, medical records, and account status. 
• Accurately document all patient account activity, communications, referrals, authorizations, and claim updates within the electronic medical record and other applicable systems. 
• Prioritize and manage multiple assignments while meeting departmental productivity, quality, and service expectations in a fast-paced environment. 
• Maintain confidentiality of patient, employee, and company information while complying with HIPAA, privacy regulations, and organizational policies. 
• Collaborate effectively with providers, clinic staff, billing personnel, and other departments to ensure efficient patient service and revenue cycle operations. 
• Perform other duties as assigned. 

Job Competencies:

Successful candidates demonstrate the ability to:

• Deliver professional, responsive, and compassionate customer service. 
• Communicate effectively with patients, providers, insurance carriers, and coworkers. 
• Maintain a high level of accuracy and attention to detail. 
• Prioritize multiple assignments and consistently meet deadlines. 
• Work independently while collaborating effectively within a team environment. 
• Adapt to changing priorities and departmental needs. 
• Analyze and resolve insurance, billing, and reimbursement issues. 
• Exercise sound judgment and maintain confidentiality. 
• Remain organized while managing multiple systems and workflows simultaneously. 
• Work effectively under pressure while maintaining quality and productivity. 
• Demonstrate professionalism, accountability, flexibility, and reliability. 
• Learn and utilize electronic medical records, billing software, payer portals, and other healthcare technology. 

Work Environment:

This position is performed in a professional office environment within the Central Support Office. The employee routinely uses standard office equipment including computers, telephones, printers, scanners, and other business technology. Frequent interaction with patients, providers, insurance carriers, and internal departments is required. The work environment is fast-paced and deadline-driven, requiring the ability to manage changing priorities while maintaining exceptional customer service and accuracy.

Physical Demands:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee is regularly required to:

• Remain in a stationary position for extended periods while working at a computer. 
• Frequently operate a computer, keyboard, mouse, telephone, copier, scanner, and other office equipment. 
• Occasionally move throughout the office to access files, equipment, or collaborate with coworkers. 
• Frequently communicate verbally and in writing with patients, providers, insurance carriers, and coworkers. 
• Occasionally lift, carry, push, or pull office materials weighing up to 15 pounds. 

Cognitive Demands:

The position requires the ability to:

• Analyze insurance benefits, claims, authorizations, and reimbursement information. 
• Apply critical thinking and sound judgment when resolving billing or insurance issues. 
• Maintain attention to detail while working across multiple systems. 
• Prioritize competing responsibilities in a fast-paced environment. 
• Interpret insurance policies, payer requirements, and company procedures. 
• Maintain concentration despite frequent interruptions. 
• Manage multiple tasks simultaneously while meeting deadlines. 
• Make decisions using established policies, procedures, and regulatory requirements. 

Vision Requirements:

Specific vision abilities required include:

• Close vision for prolonged computer use. 
• Ability to read printed and electronic documents. 
• Ability to distinguish colors, symbols, numbers, and text accurately. 
• Ability to adjust focus between computer monitors, written documents, and office equipment. 

Travel Requirements:

No routine travel is required for this position.

Compliance Responsibilities:

• Maintain compliance with all HIPAA, OSHA, federal, state, and local regulations. 
• Protect the confidentiality of patient, employee, and company information. 
• Follow all company policies, procedures, and compliance standards. 
• Complete all required compliance and continuing education training.

ADA Statement

Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of this position.

EEOC Disclosure

Salience is an Equal Opportunity Employer and is committed to creating an inclusive workplace. Employment decisions are made without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law. Salience is committed to providing reasonable accommodations to qualified individuals with disabilities and to applicants throughout the hiring process, consistent with applicable law.

Education & Experience:

Required

High School Diploma or equivalent. 

Two plus (2+) years of experience obtaining insurance verifications and prior authorizations. 

Two plus (2+) years of medical accounts receivable. 

Knowledge of reimbursement processes, and payer guidelines. 

Experience working within an electronic medical record (EMR) or practice management system. 

Preferred

Experience using Athenahealth or similar electronic medical record software. 

Experience in Psychiatry, Neurology, Behavioral Health, or Primary Care. 

Knowledge of ICD-10, CPT, and HCPCS coding. 

Bilingual (English/Spanish) is a plus. 

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