Sr. Patient Access Representative

Orsini Healthcare•Elk Grove Village, IL

7d•$25 - $25

About The Position

The Sr. Patient Access Representative provides day-to-day oversight and workflow support for frontline Benefits Verification (BV) and Prior Authorization (PA) staff while performing complex quality audits. The role helps ensure benefit investigations, authorization submissions, and recurring authorization activities are accurate, timely, complete, and compliant with payer requirements. The representative serves as a frontline resource for questions and escalations, identifies reimbursement risks, coaches staff on audit findings, and partners with Admissions, Audit, Accounts Receivable, and other teams to prevent avoidable delays and denials.

Requirements

High school diploma or equivalent from an accredited school.
Demonstrated ability to lead daily work, support staff, provide constructive feedback, and reinforce performance expectations.
Strong knowledge of major medical benefits, Medicare, Medicaid, commercial payer requirements, and policy interpretation.
Working knowledge of prior authorization requirements, authorization date spans, prescription-based unit calculations, and documentation standards.
Ability to audit work objectively, identify root causes and reimbursement risk, and communicate clear corrective action.
Strong organizational, analytical, written, and verbal communication skills.
Ability to prioritize competing work in a fast-paced environment and manage urgent patient or payer escalations.
Highly detail oriented and able to handle protected health information in accordance with HIPAA requirements.

Nice To Haves

Associate or bachelor's degree.
At least 3 years of related specialty pharmacy, benefits verification, prior authorization, reimbursement, or major medical insurance experience.

Responsibilities

Provide day-to-day oversight for frontline BV and PA staff, including work assignment, queue monitoring, coverage coordination, productivity follow-up, and support with questions.
Audit benefit investigations, prior authorization submissions, recurring authorizations, approvals, denials, and supporting documentation for accuracy and payer compliance.
Coach staff on audit findings, provide timely feedback, support onboarding and ongoing training, and identify recurring knowledge or process gaps for leadership.
Serve as the first point of escalation for complex or urgent BV and PA issues; research payer requirements and coordinate resolution with Admissions leadership, Audit, Accounts Receivable, clinical teams, and other partners.
Track audit results, turnaround times, work quality, trends, and outstanding issues; provide updates and recommendations to the Admissions Sr. Manager.
Support process improvement, standard work, policy updates, and readiness for new therapies or payer changes.
Perform other duties or projects as assigned.