Billing Eligibility Coordinator

The Billing Eligibility Coordinator is responsible for ensuring accurate and timely verification of patient insurance eligibility and maintaining current coverage information to support efficient billing operations and patient access to care. This position serves as a liaison between patients, payers, Patient Services, Billing, Care Management, and clinical staff to resolve insurance-related issues, minimize eligibility-related claim denials, and promote compliance with federal, state, HRSA, and organizational requirements. The Billing Eligibility Coordinator maintains expertise in Medicaid, Medicare, Managed Care Organizations (MCOs), commercial insurance plans, and FQHC billing requirements while supporting workflow improvements that enhance reimbursement accuracy and the patient experience.

Qualifications

Education :

• High school diploma or equivalent required
• Associates degree in medical or billing program preferred

Certifications & Licenses:

• None required.
• Insurance verification or medical billing certification preferred.

Experience:

• Two (2) years of experience in healthcare insurance verification, patient eligibility, or medical billing.
• Experience working with Medicaid, Medicare, Managed Care Organizations (MCOs), commercial insurance plans, and uninsured/sliding fee patients strongly preferred.
• Experience in an FQHC, community health center, primary care practice, or ambulatory care setting preferred.

Knowledge, Skills, Abilities:

• Working knowledge of Medicaid, Medicare, Managed Medicaid, commercial insurance plans, and payer eligibility requirements.
• Knowledge of insurance terminology, coordination of benefits (COB), prior authorization requirements, and payer portals.
• Knowledge of FQHC billing requirements, sliding fee discount programs, and payer coordination of benefits preferred.
• Familiarity with insurance verification portals, clearinghouses, and electronic health record (EHR) systems (NextGen preferred).
• Strong attention to detail with the ability to interpret insurance coverage, benefit limitations, authorizations, and payer guidelines.
• Ability to research and resolve eligibility and insurance discrepancies.
• Excellent customer service and communication skills while working with patients, providers, payers, and internal departments.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Essential Duties and Responsibilities

Eligibility & Insurance Coordination

• Verify and maintain patient insurance eligibility for Medicaid, Medicare, commercial insurance, Marketplace plans, and other third-party payers.
• Review patient insurance information prior to appointments to ensure coverage is active and accurate.
• Research and resolve eligibility discrepancies, coverage issues, and coordination of benefits.
• Assist patients with insurance updates, coverage questions, and documentation needed to establish eligibility.
• Coordinate with Patient Services Representatives, Billing, Care Management, and clinical staff to resolve insurance-related issues.
• Ensure insurance information is accurately entered and maintained within the electronic health record.
• Contact payers, patients, and employers, as appropriate, to obtain or verify insurance information.

Payor & Billing Support

• Maintain knowledge of payer-specific billing and eligibility requirements.
• Monitor changes in Medicaid, Medicare, managed care organizations, and commercial payer policies that affect patient eligibility and reimbursement.
• Collaborate with the Billing team to resolve eligibility-related claim edits, denials, and payer inquiries.
• Identify trends in eligibility denials and recommend workflow improvements to reduce preventable claim rejections.

Quality & Compliance

• Ensure compliance with HRSA, FQHC, Medicaid, Medicare, and organizational requirements related to patient eligibility.
• Participate in internal audits related to insurance eligibility and registration accuracy.
• Maintain accurate documentation within the electronic health record.
• Assist with staff education regarding payer requirements and eligibility processes.

Additional Duties

• Assist with departmental projects, workflow improvements, audits, and other initiatives as assigned by the Director of Revenue Cycle or Chief Financial Officer.
• All other duties as assigned.

Work Environment & Schedule

• Must be able and comfortable working in a variety of settings including, but not limited to clinical environments and office spaces.
• Must be able to work nights and weekends as departmental needs arise.

Travel Requirements

• NA

Core Competencies

• Communication: Demonstrates strong verbal, written, and digital communication skills; able to clearly explain complex information.
• Judgment & Decision-Making: Provides thoughtful input into operational and program decisions.
• Accountability & Self-Management: Works independently and efficiently, managing multiple responsibilities with minimal supervision.
• Teamwork & Collaboration: Builds effective working relationships across teams, departments, and the community.
• Problem-Solving & Initiative: Applies critical thinking and initiative to resolve issues and improve service delivery.

Service Delivery Expectations

• Demonstrates compassion and respect in all interactions, treating patients, community members, and colleagues with dignity and cultural sensitivity.
• Supports the organization’s mission to improve the health of our communities by helping ensure services, information, and resources are accessible to those we serve.
• Communicates clearly and effectively with diverse populations while actively listening and responding to community needs.
• Maintains confidentiality and handles sensitive information with professionalism and integrity.
• Upholds organizational standards, policies, and procedures while promoting high-quality service and continuous improvement.
• Demonstrates accountability and stewardship by managing time effectively, prioritizing responsibilities, and meeting deadlines.
• Shows awareness of the community served and supports initiatives that improve access to care and health education.
• Projects a professional image and collaborates with colleagues, providing guidance or leadership when coordinating activities or supporting team efforts.
• Maintains compliance with HIPAA and patient confidentiality requirements.
• Follows workplace safety standards and infection control policies when present in clinical environments.

Physical Demands

• Prolonged periods of sitting while working at a computer and viewing screens.
• Frequent use of hands and fingers for typing, writing, and operating office equipment.
• Requires close visual acuity to read screens, prepare and review documents, and assess information.
• Occasional standing and walking.
• Ability to move throughout office and clinical spaces as needed to perform job duties.
• Occasional lifting, carrying, or moving materials, equipment, or supplies weighing up to 25–50 pounds.
• Ability to communicate clearly and effectively, both verbally and in writing.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Supervisory & Leadership Responsibilities

• NA

Compliance Responsibilities

As part of Kinston Community Health Center’s commitment to ethical practices and regulatory compliance, all employees are expected to:

• Act in accordance with the KCHC Employee Handbook, policies and procedures, and all applicable federal and state laws.
• Promptly report any known or suspected violations of compliance/safety standards.

These responsibilities are essential to maintaining a culture of integrity and accountability across the organization.

Background Requirements

• Must successfully pass required background checks in accordance with organizational policy.

• Must comply with all organizational credentialing and screening requirements.