Patient Eligibility Coordinator - Remote

Overview

The Patient Eligibility Coordinator is responsible for verifying insurance coverage, obtaining authorizations, and ensuring all necessary documentation is in place before services are provided. This role is crucial in preventing billing delays, identifying financial risks, and ensuring a smooth patient experience.

In Short

• Verify patient eligibility, benefits, and coverage with insurance providers.
• Confirm co-pays, deductibles, coinsurance, and out-of-pocket costs.
• Process and obtain prior authorizations and referrals as required.
• Notify patients of their insurance coverage, benefits, and financial responsibilities.
• Assist patients with financial assistance options, payment plans, and alternative coverage solutions.
• Work closely with scheduling, clinical, and billing teams to address eligibility concerns.
• Communicate with medical billers to ensure claim submissions are accurate.
• Document all verification details, approvals, and patient interactions in the EHR system.
• Identify and troubleshoot insurance coverage issues, such as terminated policies or missing authorizations.
• Stay updated on payer policies and requirements to ensure compliance and accuracy.

Requirements

• Knowledge of Medicaid, Medicare, and commercial insurance plans.
• Ability to troubleshoot coverage issues efficiently.
• Strong verbal and written communication skills for patient and provider interactions.
• Experience with EHR systems, payer portals, and eligibility verification tools.
• Ability to manage multiple verifications and authorizations daily.
• High school diploma or GED required; Associate’s degree in Healthcare Administration or a related field preferred.
• Minimum of 2+ years of experience in insurance verification, patient access, or a related healthcare role.
• Certification in medical billing and coding (e.g., CPC, CCA) or patient access (e.g., CHAA) is a plus.
• Familiarity with CPT, ICD-10, and HCPCS codes for prior authorizations.
• Knowledge of HIPAA regulations and compliance standards.
• Experience utilizing NextGen, preferred.

Benefits

• PTO Accruals Start at 3 Weeks
• Comprehensive Medical and Dental Insurance
• Company-Paid Optical Allowance
• Company-Paid Routine Eye Care
• Short-Term and Long-Term Disability Insurances
• Educational Allowance
• Paid Holiday Program
• 401K with Company Match