Job Description

Responsible for managing all insurance-related processes within a healthcare setting. The role ensures that patients' insurance information is accurate, claims are submitted correctly, and reimbursements are processed efficiently. This position requires strong knowledge of medical billing, insurance policies, and healthcare regulations.

Key Responsibilities

Verify patients' insurance coverage, eligibility, and benefits prior to appointments or treatment. Obtain prior authorizations and pre-certifications for procedures, referrals, and medications. Review and process medical claims, ensuring coding accuracy (ICD-10, CPT, HCPCS). Work with insurance companies to resolve claim denials, rejections, and billing discrepancies. Explain insurance benefits, coverage, and financial responsibilities to patients. Maintain accurate patient records, authorization logs, and billing documentation. Coordinate with clinical staff, billing departments, and insurance representatives. Monitor claim status and follow up on outstanding payments. Ensure compliance with HIPAA and other healthcare regulations. Assist in financial counseling and payment plan setup when needed.

Required Skills & Qualifications

Knowledge of medical terminology, insurance plans, and claims processing. Familiarity with billing software (e.g., Epic, Cerner, Athenahealth, or similar systems). Strong attention to detail and ability to analyze claim information. Excellent communication and customer service skills. Ability to handle confidential information professionally. Problem-solving and time-management abilities. High school diploma required; associate's degree or certification in medical billing/coding preferred.

Work Environment

Medical Insurance Coordinators typically work in hospitals, clinics, physician offices, or insurance companies. Most work is office-based, involving computer systems, phone communication, and coordination with both patients and staff.

Job Type: Full-time