Billing and Benefits Coordinator

Primary Duties And Responsibilities

• Verify patient insurance eligibility and benefits prior to services, ensuring accurate documentation in the system.
• Process insurance enrollments, updates, and authorizations to support timely and accurate billing.
• Communicate with patients to explain coverage, co-pays, deductibles, and out-of-pocket responsibilities.
• Help clients, and sometimes their family members, complete and submit applications for Medicaid, Social Security Income (SSI), Social Security Disability Insurance (SSDI), or the Supplemental Nutrition Assistance Program (SNAP).
• Provide support throughout the application process, including preparing appeals for denied benefits and following up with agencies like Social Security and Medicaid.
• Conduct meetings to educate clients on their insurance coverage, eligibility, and the options available to them for mental health and other community services.
• Gather, verify, and input clients' social, financial, and medical information into various applications and databases.
• Work with the Electronic Health Record (EHR) team to ensure accuracy and efficiency in billing and coding processes.
• Maintain accurate client benefits records, process enrollment changes and terminations, and track application statuses.
• Ensure claims are clean and free of errors prior to submitting to the billing department.
• Audit medical record documentation to identify miscoded and under/up coded entries and train on accurate coding practices and compliance issues.
• Work closely with other identified clinical staff to ensure best clinical standards and coding is followed.
• Liaise between clients, families, providers, front office staff, and billing teams to resolve insurance-related issues.
• Submit and follow up on prior authorizations, referrals, and benefit inquiries with payers.
• Monitor payer portals and correspondence for updates, coverage changes, or denials.
• Educate patients about financial assistance programs or alternative payment options as needed.
• Ensure compliance with HIPAA and organizational policies in handling patient and payer information.
• Contribute to departmental goals of reducing denials, improving collections, and enhancing patient satisfaction.

Qualifications

• High School diploma or equivalent (Associates or Bachelor’s degree preferred.)
• 2+ years of experience in insurance verification, benefits coordination, or revenue cycle operations.
• Valid Michigan Driver’s License and Vehicle Insurance.
• Knowledge of medical billing, insurance processes, and payer requirements.
• Strong communication and customer service skills.
• Proficiency in electronic health records (EHR) and insurance portal systems.
• Detail-oriented with strong organizational and problem-solving abilities.
• Ability to work independently and collaboratively in a fast-paced environment.
• Preferred Certifications: Certified Revenue Cycle Representative (CRCR) – Healthcare Financial Management Association (HFMA); Certified Healthcare Access Associate (CHAA) – National Association of Healthcare Access Management (NAHAM); Certified Patient Account Representative (CPAR) – State/Regional certification (where applicable); Other healthcare administrative or billing-related certifications (CMAA, CPC) considered a plus.