Billing Eligibility Coordinator

About the role

The Billing Eligibility Coordinator is responsible for ensuring accurate and timely verification of patient insurance eligibility and maintaining current coverage information to support efficient billing operations and patient access to care. This position serves as a liaison between patients, payers, Patient Services, Billing, Care Management, and clinical staff to resolve insurance-related issues, minimize eligibility-related claim denials, and promote compliance with federal, state, HRSA, and organizational requirements.

Responsibilities

• Verify and maintain patient insurance eligibility for Medicaid, Medicare, commercial insurance, Marketplace plans, and other third-party payers.
• Review patient insurance information prior to appointments to ensure coverage is active and accurate.
• Research and resolve eligibility discrepancies, coverage issues, and coordination of benefits.
• Aid patients with insurance updates, coverage questions, and documentation needed to establish eligibility.
• Coordinate with Patient Services Representatives, Billing, Care Management, and clinical staff to resolve insurance-related issues.
• Maintain insurance information accurately within the electronic health record.
• Contact payers, patients, and employers, as appropriate, to obtain or verify insurance information.
• Maintain knowledge of payer-specific billing and eligibility requirements.
• Monitor changes in Medicaid, Medicare, managed care organizations, and commercial payer policies that affect patient eligibility and reimbursement.
• Collaborate with the Billing team to resolve eligibility-related claim edits, denials, and payer inquiries.
• Identify trends in eligibility denials and recommend workflow improvements to reduce preventable claim rejections.
• Ensure compliance with HRSA, FQHC, Medicaid, Medicare, and organizational requirements related to patient eligibility.
• Participate in internal audits related to insurance eligibility and registration accuracy.
• Maintain accurate documentation within the electronic health record.
• Aid with staff education regarding payer requirements and eligibility processes.

Qualifications

• High school diploma or equivalent required.
• Associates degree in medical or billing program preferred.
• Insurance verification or medical billing certification preferred.
• Two (2) years of experience in healthcare insurance verification, patient eligibility, or medical billing.
• Experience working with Medicaid, Medicare, Managed Care Organizations (MCOs), commercial insurance plans, and uninsured/sliding fee patients strongly preferred.
• Experience in an FQHC, community health center, primary care practice, or ambulatory care setting preferred.

Skills

• Working knowledge of Medicaid, Medicare, Managed Medicaid, commercial insurance plans, and payer eligibility requirements.
• Knowledge of insurance terminology, coordination of benefits (COB), prior authorization requirements, and payer portals.
• Knowledge of FQHC billing requirements, sliding fee discount programs, and payer coordination of benefits preferred.
• Familiarity with insurance verification portals, clearinghouses, and electronic health record (EHR) systems (NextGen preferred).
• Strong attention to detail with the ability to interpret insurance coverage, benefit limitations, authorizations, and payer guidelines.
• Ability to research and resolve eligibility and insurance discrepancies.
• Excellent customer service and communication skills while working with patients, providers, payers, and internal departments.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Benefits

Not specified.

Pay

Commensurate with experience.

Schedule

N/A.