Patient Service Representative

EDGE is dedicated to connecting top global talent with the US Healthcare and Insurance industry. Our mission is to build a borderless network of exceptional professionals, placing people at the heart of everything we do. We are currently seeking a Patient Service Representative to support US-based healthcare providers. The ideal candidate will have experience in the US healthcare sector, particularly in scheduling, eligibility verification, prior authorizations, and insurance verification. This role serves as a vital link between patients, healthcare providers, and insurance companies, requiring a detail-oriented and tech-savvy individual who can efficiently navigate insurance portals and electronic health records to ensure patients receive timely care.

Key Responsibilities
- Conduct thorough eligibility checks and benefits verification for patients before their appointments.
- Interpret complex insurance policies, including PPO, HMO, and Medicare/Medicaid guidelines.
- Determine patient financial responsibilities such as deductibles, copays, and coinsurance, and document these accurately in the practice management system.
- Prepare, compile, and submit prior authorization requests to insurance companies through web portals, fax, or phone.
- Review clinical documentation (progress notes, lab results, physician orders) to confirm medical necessity before submission.
- Monitor the status of pending authorizations, manage appeals for denied claims, and expedite urgent requests to avoid delays in patient care.
- Manage inbound and outbound patient calls to schedule, reschedule, and remind patients of wellness visits and routine check-ups.

Required Qualifications
- Minimum of 1 year of direct experience in the US healthcare industry, including scheduling, eligibility, prior authorizations, and insurance verification.
- Strong understanding of US insurance concepts such as PPO, HMO, EOBs, copays, patient benefits eligibility verification, prior authorizations, and scheduling.
- Proficiency in using insurance portals like Availity, Optum, Covermymeds, and electronic health record/practice management systems such as ECW, Tebra, or Dentrix.
- Exceptional attention to detail, strong analytical skills, and excellent written and verbal communication in English.
- Ability to work independently in a fast-paced environment.

Hiring Process
Candidates will undergo a multi-step hiring process starting with an application review. Selected applicants will be invited for an interview with an Edge representative to discuss their fit for the role. Successful candidates will then complete onboarding and training before participating in client interviews. Upon final selection, candidates join the Edge Global Talent Community, ready to contribute meaningfully to healthcare organizations.

About EDGE
EDGE strives to eliminate geographic barriers to employment by creating a global hiring network that connects exceptional talent worldwide with North American businesses. Our Talent Network is a community where professionals can unlock their potential, showcase their skills, and earn competitive wages.

Equal Opportunity Employer
EDGE is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities to all qualified applicants regardless of race, color, religion, gender identity or expression, sexual orientation, national origin, disability, age, veteran status, or any other legally protected status.

Candidates interested in accelerating their application process are encouraged to create a profile on our talent platform.