Insurance Eligibility Coordinator

Insurance Eligibility Coordinator

The Insurance Eligibility Coordinator is responsible for verifying patient insurance coverage, ensuring accurate benefit information, and supporting efficient revenue cycle operations. This role works closely with patients, insurance carriers, clinical staff, and billing teams to confirm eligibility, resolve coverage discrepancies, and help prevent claims denials.

Essential Functions

• Verify patient insurance eligibility and benefits using electronic systems, payer portals, and direct insurance carrier communication.
• Accurate document coverage details, copayments, deductibles, prior authorization requirements, and plan limitations. Prepare and submit claims in a timely and accurate manner.
• Identify and correct rejected claims for prompt resubmission
• Submit and follow up on authorization requests.
• Follow up on denied or unpaid claims and work to resolve discrepancies.
• Post payments and adjustments to patient accounts in a timely manner.
• Communicate with insurance companies and internal staff regarding billing inquiries or issues.
• Maintain up-to-date knowledge of payer rules, policy changes, and medical coverage guidelines.
• Protect patient privacy and maintain compliance with HIPAA and organizational standards.
• Support revenue cycle improvement initiatives related to eligibility and insurance workflows.
• Participate in team meetings and contribute to quality improvement initiatives.
• Adhere to practice policies, procedures, and protocols including confidentiality.
• Other tasks as assigned.
• Travel: 100% Remote

Qualities & Skills

• Strong understanding of insurance plans, terminology, HMOs, PPOs, Medicare/Medicaid and commercial payer policies in NJ, NY, & PA.
• Excellent communication, customer service, and problem-solving skills.
• Proficiency with medical practice management software, EHR systems, and payer portals.
• Ability to multitask and work in a fast-paced environment.
• Strong Knowledge of Microsoft Office Suite.
• Comfortable working independently and collaboratively.
• Outstanding problem solver and analytical thinking skills.
• Attention to detail and ability to prioritize.
• Ability to maintain confidentiality.
• Experience in Behavioral health is preferred.

Education & Experience

• High School diploma or equivalent required.
• 1-2 years of experience in medical insurance verification, medical billing, or related roles