Insurance Coordinator

Job Summary:

The Insurance Coordinator is responsible for ensuring accurate and timely reimbursement from third-party payers by coordinating insurance billing, claim follow-up, denial resolution, and communication with insurance companies. This position works collaboratively with clinical departments, patient access, coding and finance to ensure claims are processed efficiently while maintaining compliance with payer and regulatory requirements.


Essential Duties and Responsibilities:

• Review claims for completeness and accuracy prior to submission
• Submit electronic and paper claims to commercial, Medicare, Medicaid, and managed care payers
• Correct claim edits and resolve billing errors
• Monitor claim acceptance and rejections
• Follow up on unpaid, denied, or partially paid claims
• Contact insurance companies regarding claim status
• Document all payer communications in the patient accounting system
• Research payer policies and reimbursement guidelines
• Escalate complex reimbursement issues when appropriate
• Analyze denials and identify root causes
• Prepare and submit timely appeals and supporting documentation
• Monitor appeal outcomes
• Identify denial trends and recommend process improvements
• Review accounts receivable aging reports
• Prioritize high-dollar and timely filing accounts
• Resolve payment discrepancies and underpayments
• Request corrected claims or rebills as needed
• Coordinate with registration, coding, utilization review, case management, and providers to obtain needed information/documentation
• Maintain compliance with HIPAA and organizational policies
• Stay current on payer policy changes
• Follow Medicare, Medicaid, and commercial insurance billing guidelines
• Ensure timely filing requirements are met
• Maintain accurate account notes
• Document all follow-up activities
• Maintain records supporting appeals and payment resolution
• All other duties assigned

Performance Expectations:

• Meet daily productivity goals for accounts worked
• Maintain high-quality documentation
• Resolve claims within established turnaround times
• Meet departmental cash collection goals
• Minimize accounts exceeding 90 days
• Reduce avoidable denials
• Work collaboratively across departments
• Demonstrate accountability and ownership of assigned accounts

Qualifications:

Education/Skills:

• A high school diploma or equivalent required
• Associate's or Bachelor's Degree in Accounting, Business, Healthcare Administration or related field preferred
• 2-4 years of healthcare billing, insurance follow-up, or revenue cycle experience preferred
• Experience with hospital or physician billing
• Knowledge of Medicare, Medicaid, and commercial insurance
• Knowledge of medical terminology, CPT, HCPCS, and ICD-10 coding principles
• Familiarity with electronic health records (EHR) and patient accounting systems
• Strong analytical and problem-solving skills
• Excellent written and verbal communication
• Ability to manage multiple priorities and meet deadlines

Work Location:

This position follows a hybrid work schedule. Regular onsite presence is required to support staff, attend meetings, and ensure operational effectiveness, with remote work available as approved based on departmental needs and performance.