Job Description

Job Summary

The Insurance Coordinator is responsible for verifying patient insurance eligibility, obtaining necessary pre-certifications and authorizations, and ensuring compliance with payer requirements. This role plays a vital part in maximizing reimbursement, reducing denials, and supporting patient access to care by maintaining accurate documentation and coordinating with insurance companies, physicians, and other stakeholders. The Insurance Coordinator serves as a key resource for navigating insurance-related processes across the organization.

Essential Functions

Verifies patient insurance eligibility, benefits, and coverage details, ensuring accurate information is recorded and communicated to relevant stakeholders. Initiates and manages pre-certification and prior authorization requests, including gathering required documentation and submitting requests to insurance providers. Tracks and maintains authorization status, following up with payers and provider offices to resolve pending or denied requests. Collaborates with physicians, clinical staff, and case management to ensure proper documentation is obtained for insurance approvals. Educates patients and staff on insurance processes, coverage limitations, and financial responsibilities as they relate to pre-certifications and prior authorizations. Monitors and updates tracking systems for pre-authorized visits and ensures authorizations remain current throughout the course of treatment. Assists with resolving insurance claim denials and payment discrepancies by coordinating with billing, revenue cycle, and payer representatives. Maintains knowledge of evolving payer policies, reimbursement guidelines, and industry best practices related to insurance verification and pre-certifications. Ensures compliance with HIPAA regulations and organizational policies related to patient information, confidentiality, and documentation. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

H.S. Diploma or GED required 1-3 years of experience in insurance verification, prior authorization, patient access, or revenue cycle management within a healthcare setting required Experience working with managed care organizations, government payers, and commercial insurance providers preferred

Knowledge, Skills and Abilities

Strong understanding of insurance verification, pre-authorization, and reimbursement processes. Knowledge of healthcare payer policies, medical necessity guidelines, and insurance terminology. Proficiency in using electronic health record (EHR) systems and insurance verification portals. Excellent communication and customer service skills to interact effectively with patients, staff, and insurance representatives. Ability to manage multiple priorities, meet deadlines, and work independently. Strong problem-solving skills and attention to detail. Familiarity with HIPAA regulations and compliance requirements.