Care Team Representative - Insurance Specialist

Company: Associated Physicians, LLP
Location: Madison
Posted on: April 10, 2025

Job Description:

*GENERAL SUMMARY:* The Patient Access Representative, under the general direction of the Patient Access Supervisor, will coordinate the scheduling, referral management, registration, prior authorization, and insurance verification processes for patients of Associated Physicians (AP). This position will identify and handle customer needs, providing exceptional customer service in a timely and efficient manner while working in a team environment. They will screen and update new or established patient information for accuracy, and schedule appointments according to departmental scheduling protocols

Check out the role overview below If you are confident you have got the right skills and experience, apply today.

*QUALIFICATIONS:*

*Required:* High school diploma or equivalent; prior customer service experience; knowledge of computerized scheduling and registration; telephone communication skills; standard keyboarding skills; use of usual and customary equipment used to perform essential functions of the position; pleasant, outgoing personality; ability to perform multiple tasks in a fast-paced environment; ability to perform effectively in stressful situations (upset patients, providers and equipment/software malfunctions); excellent organization, planning, and prioritization skills; ability to work independently and assume responsibility for timely completing of assigned tasks/functions; clear and effective written and verbal communication skills to communicate with people of diverse, professional, educational and lifestyle backgrounds patiently and professionally; ability to establish and maintain effective working relationships with providers, staff, patients, other healthcare facilities, service providers, and general public; ability to meet guidelines for dependability and punctuality; and knowledge of clinic policies and procedures related to infection control, environmental safety, and patient confidentiality. Ability to maintain patient confidentiality both inside and outside the work environment.

*Preferred:* One year of experience in a healthcare/office setting performing scheduling, registration, insurance verification and/or billing functions; working knowledge and experience with medical terminology, insurance terminology and processes, and verifying insurance using various websites/software. Knowledge of healthcare operations and prior Epic experience highly preferred.

*PRINCIPAL DUTIES AND RESPONSIBILITIES:*

*Scheduling*

1. Schedules, manages referrals, and completes the full registration and insurance verification for patients, including screening for high-risk payers.

2. Screens inbound calls, evaluating patient/customer needs to determine appropriate appointment department and provider of care, based on conversation with patient, provider, order received, urgency of care, and/or patient convenience to time and location.

3. Responds to inbound calls regarding scheduling, rescheduling, canceling, confirming, registration, late arrivals, electronic eligibility, etc. as applicable.

4. Initiates outbound calls to schedule appointments, complete registration and verify electronic eligibility for orders, referrals, recalls, and waitlists.

5. Accurately establishes and maintains all patient data required to correctly identify the patient, verify insurance, establish a clean claim, and meet Centers for Medicare & Medicaid Services and billing requirements to ensure patient safety, continuity of care, and maximum reimbursement for the organization.

6. Identifies and handles customer needs, providing exceptional customer service in a timely and efficient manner while working in a team environment.

*Patient Registration*

1. Acts as a resource for providers, other staff, and patients and their family members.

2. Identifies and responds to customer needs, providing exceptional customer service in a timely and efficient manner while working in a team environment.

3. Utilizes critical thinking skills to identify, troubleshoot, and resolve escalated patient issues, following through to ensure customer satisfaction. 4. Quality Assurance

5. Assists with assigned work queues, reports, and additional tasks as assigned.

*Communication, Collaboration, and Culture*

1. Provides exemplary customer service by demonstrating a personal commitment to patient satisfaction.

2. Conducts patient check-in and check-out in an accurate, efficient, and friendly manner.

3. Understands and carries out basic safety, security, and emergency procedures of the clinic.

4. Continuously promotes, communicates, and embodies the AP mission and values.

5. Practices and encourages a positive attitude among teammates to stimulate enhanced communication and collaboration.

6. Provides information to patients about clinic services to optimize patient experience.

7. Actively participates within team and during staff meetings to promote improvement of operating strategies, patient satisfaction, and financial reimbursement.

8. Willingly assists teammates and takes on additional assignments.

9. Interacts with patient and teammates in a professional, respectful, and positive manner and discourages gossip, rumors, and non-constructive communications in the workplace.

*Systems/Training*

1. Assists with Epic upgrade testing and implementation.

2. Trains and mentors new and existing staff as needed.

*Basic Performance Criteria*

1. Continuously promotes, communicates, and embodies the AP mission and values.

2. Adheres to policies, procedures, and safety guidelines.

3. Demonstrates and utilizes critical thinking skills.

4. Demonstrates ability to meet business needs of department with regular, reliable attendance.

5. Practices and reflects knowledge of the Health Insurance Portability and Accountability Act (HIPAA), TJC, DNV, Occupational Safety and Health Administration (OSHA) guidelines and other federal/state regulatory agencies affecting healthcare.

6. Completes all annual education and competency requirements within the prescribed period at time of hire and annually thereafter.

7. Understands department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of their direct supervisor or manager. Takes appropriate action on concerns reported by department staff related to compliance.

*ENVIRONMENTAL/WORKING CONDITIONS:*

Office setting. Occasional exposure to communicable diseases and other conditions common to a clinic environment. Frequent contact with providers, staff, service providers, patients, pharmaceutical representatives, and general public.

*PHYSICAL/MENTAL DEMANDS:*

Must be able to speak, hear, and see. Must have fine motor coordination to operate computer and telephone. Occasional stress from dealing with high volume of calls, upset patients and/or emergency situations. Varied activities including standing, sitting, walking, reaching, twisting, bending, stooping, and kneeling. Requires full range of body motion. Activities may include occasional lifting and carrying of objects weighing up to 10 pounds.

NOTE: This description is intended to provide basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change at any time as needs evolve.

Job Type: Full-time

Pay: $20.17 - $23.40 per hour

Expected hours: 40 per week

Benefits:
* 401(k)
* 401(k) matching
* Dental insurance
* Disability insurance
* Employee assistance program
* Flexible spending account
* Health insurance
* Health savings account
* Life insurance
* Paid time off
* Referral program
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday
* Weekends as needed



Ability to Relocate:
* Madison, WI 53705: Relocate before starting work (Required)

Work Location: In person

Keywords: Associated Physicians, LLP, Madison , Care Team Representative - Insurance Specialist, Other , Madison, Wisconsin