Healthcare Account Representative

Who We AreEDGE is building a bridge between Top Global Talent and the US Healthcare & Insurance Industry. We are on a mission to create a borderless network of exceptional talent with people at the center of everything we do. See our values and more on onedge.co.Role OverviewWe are looking for Healthcare Account Representative for US-based healthcare providers. The ideal candidate has experience working in the US Healthcare industry (scheduling, eligibility, prior authorizations, insurance verification, etc.)Operating as a key member for US based clinics and healthcare practices, this professional will act as a critical liaison between patients, healthcare providers, and insurance companies. The position requires a meticulous, tech-savvy individual capable of navigating complex insurance portals and electronic health records, while ensuring patients receive timely access to the care they need.Key ResponsibilitiesConduct comprehensive eligibility checking and benefits verification for patients prior to their scheduled appointments.Accurately interpret complex insurance policies, differentiating between PPO, HMO, and Medicare/Medicaid guidelines.Determine patient financial responsibilities, including deductibles, copays, and coinsurance, and clearly document these findings within the practice management system.Prepare, compile, and submit prior authorization requests to insurance companies via web portals, fax, or phone.Review clinical documentation (progress notes, lab results, physician orders) to ensure medical necessity criteria are met before submission.Proactively track the status of pending authorizations, manage appeals for denied claims, and expedite urgent requests to prevent delays in patient care.Handle inbound and outbound calls to patients to schedule, reschedule, and remind them of wellness visits and routine checks.RequirementsMust have at least 1 year of direct experience in the US Healthcare industry, scheduling, eligibility, prior authorizations, insurance verification, etc.Deep understanding of US insurance concepts, including PPO, HMO, EOBs, copays, and patient benefits eligibility verification, prior auth and scheduling.Proficiency in navigating insurance portals (e.g., Availity, Optum, Covermymeds, etc) and electronic health record/practice management systems (e.g., ECW, Tebra, Dentrix etc).Exceptional attention to detail, strong analytical skills, excellent written and verbal English communication, and the ability to work independently in a fast-paced environment.Our Hiring ProcessApplication Review: Submit your application and resume. Our team carefully evaluates all candidates to ensure a good fit.Edge Interview: You'll be invited to connect with a representative from Edge to present a detailed and tailored fit to your profile.Client Interviews: Successful candidates finish an onboarding & training phase and are placed in client interviews to showcase their skills and align with specific client needs.Final Selection: Once a good match is made, you’ll join the Edge Global Talent Community, ready to make an impact in the world of healthcare.Talent BoilerplateAt Edge, we’re on a mission to create a world where geographic borders are no longer a barrier for people to obtain full-time employment and fair wages. That’s why we’ve created a global hiring network that seamlessly connects exceptional talent from all over the world with businesses in North America that most need to fill positions. The Edge Talent Network is a community of like-minded professionals through which you can unlock your potential, showcase your skills, and earn what you’re worth.Equal Opportunity Employer StatementEdge is proud to be an equal-opportunity employer. We are committed to fostering a diverse and inclusive work environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, physical or mental disability, age, veteran status, or any other legally protected basis.
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