Insurance Coordinator

DEPARTMENT: Revenue Cycle Management
REPORT TO: Revenue Cycle Manager
STATUS: Non-Exempt
UNION AFFILIATION: Non-Union
SCHEDULE: Full time, 40 hours per week

JOB OVERVIEW:
The Insurance Coordinator will have responsibility and accountability for ensuring that the insurance prerequisites for indicated patient populations have been met prior to the scheduled appointment with internal and/or external providers.

ESSENTIAL FUNCTIONS:

1. The Insurance Coordinator will verify patients’ primary and secondary insurance coverage and eligibility to receive scheduled services prior to the scheduled appointment or upon arrival for walk-in visits as assigned.
2. Responsible for recording and updating patient records to reflect current active insurance and status, while ensuring the current insurance identification card is on file.
3. Determine eligibility for specialty services through verification of insurance. In addition, might identify services available within the practice based on the patients’ referral and benefit eligibility.
4. Review and update all coordination of benefit (“COB”) information, as necessary, including primary and secondary insurance.
5. Coordinate specialty services and referral appointments for patients as needed ensuring the referral and pre-authorization has been both appropriately completed and obtained if necessary.
6. Share in the scheduling of specialty appointments.
7. Communication with patients regarding any pre-authorization denial and other relevant activity relative to their access to care.
8. Will review internal referrals making any required changes relative to referred provider appointment location and/or date. He or she will further task to the Customer Service Representative this information as it relates to external referrals.

SKILLS REQUIRED:

1. Excellent communication, organization and time management skills with a demonstrated ability to effectively prioritize work with minimal supervision.
2. Demonstrate a significant competence in health insurance eligibility criteria with broad-based knowledge of the health insurance payer system and processes.
3. Must be well adept to multi-task and follow through.
4. Ability to utilize various computer systems, including but not limited to MS-Office.

EXPERIENCE REQUIRED:
A minimum of (1) year experience in healthcare in a related capacity.

EDUCATION REQUIRED:
Minimum requirement is a High School diploma or equivalency. Some post-secondary education is preferred but not required.

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