Insurance Eligibility and SFS Coordinator

About the Role

The Insurance Eligibility and SFS Coordinator participates in delivering excellent medical services in a patient-centered medical home environment, emphasizing disease prevention. This role involves verifying patient insurance eligibility, determining Sliding Fee Scale (SFS) eligibility, and maintaining accurate patient demographic and insurance information to support timely access to care and accurate reimbursement. The position ensures compliance with payer requirements, accurate data entry, and confidentiality of patient information while providing excellent and affordable healthcare.

Responsibilities

• Verify patient insurance eligibility, interpret payer guidelines, and coordinate benefits.
• Understand Medicare, Medicaid, Managed Care, and commercial insurance plans.
• Interpret Explanation of Benefits (EOB).
• Verify patient identity and medical insurance; determine eligibility for Sliding Fee Scale.
• Remind patients of upcoming appointments, follow-up visits, and referrals.
• Maintain and ensure patient confidentiality.
• Update the Electronic Medical Record (EMR) with accurate insurance information, demographic changes, primary care provider (PCP), co-pays, and coverage details.
• Correct insurance entry errors impacting patient eligibility, laboratory billing, claims processing, and reimbursement.
• Ensure patient insurance coverage and eligibility accuracy to prevent claim denials.
• Provide accurate and detailed phone messages to other team members.
• Obtain patient consent/signature(s) when necessary.
• Review and reconcile Quest Diagnostics and LabCorp invoices for accuracy and completeness.
• Investigate and dispute Quest Diagnostics and LabCorp billing discrepancies, including duplicate charges, incorrect patient information, insurance billing errors, and coding issues.
• Research and correct insurance eligibility, payer information, and demographic errors in the EMR to ensure accurate billing.
• Maintain a safe, secure, and healthy work environment by establishing and following standards and procedures; comply with legal regulations.
• Ensure front office and clinic policies and procedures are always followed.
• Update job knowledge by participating in educational opportunities and reading professional publications.
• Attend and actively participate in staff meetings.
• Develop and maintain a tracking and dating system for SFS applications and the number of patients applying for Medicaid.
• Monitor and resolve financial discrepancies in conjunction with the accounting department.
• Promote and demonstrate Hope values: Gospel motivation, Prayer, Excellence, Stewardship, Patience, Thankfulness, Humility, Service, Dignity through Relationship, Hospitality, and Joy.
• Maintain a courteous and professional demeanor.
• Uphold compliance with HIPAA and protect patient information.
• Ensure compliance with all 19 Health Resources and Services Administration (HRSA) Health Center Program Requirements.
• Actively participate in and support quality improvement activities and clinical practice team efforts, emphasizing individual patient needs.

Requirements

• At least 1 year of insurance verification experience in a medical clinic or facility (Required).
• Fluency in English (Required).
• Fluency in Spanish (Required).
• High School Diploma or equivalent (Required).

Skills

• Faith and belief that Hope is a ministry of God, exemplifying the love of Christ.
• Knowledge of CPT and ICD-10-CM coding.
• Ability to operate general office machinery (computers, calculators, copy/fax machines, telephones, etc.).
• Outstanding ability to build interpersonal relationships at all levels.
• Excellent communication skills, both written and verbal.
• Demonstrated passion for community healthcare.
• Proven leadership, teambuilding, and organizational skills.
• Ability to maintain integrity in a fast-paced and high-demand environment.
• Ability to manage performance goals.
• Ability to interact with people from all ethnic backgrounds, ages, and lifestyles; ability to understand and respond appropriately, effectively, and sensitively to special populations.

Physical Demands

• Occasional standing, walking, lifting, reaching, kneeling, bending, stooping, pushing, pulling, and lifting/moving up to 25 pounds.
• Frequent sitting.
• Manual dexterity.
• Good reading eyesight and vision for close work.
• Ability to communicate by speaking and hearing in person or on the phone.
• Ability to travel to various locations.