Insurance Eligibility and SFS Coordinator

About the Role

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

Responsibilities

• Verify patient insurance eligibility, including knowledge of payer guidelines and coordination of benefits.
• Interpret Medicare, Medicaid, Managed Care, and commercial insurance plans, as well as Explanation of Benefits (EOB).
• Confirm patient identity and insurance details, and determine eligibility for Sliding Fee Scale (SFS).
• Remind patients of upcoming appointments, follow-up visits, and referrals.
• Maintain patient confidentiality at all times.
• Update the Electronic Medical Record (EMR) with accurate insurance, demographic, primary care provider (PCP), co-pay, and coverage details.
• Correct insurance entry errors that impact eligibility, laboratory billing, claims processing, and reimbursement.
• Ensure accuracy of patient insurance coverage to prevent claim denials.
• Provide detailed and accurate phone messages to team members.
• Obtain patient consent and signatures when necessary.
• Review and reconcile Quest Diagnostics and LabCorp invoices for accuracy and completeness.
• Investigate and dispute billing discrepancies, including duplicate charges, incorrect patient information, insurance errors, and coding issues.
• Research and correct insurance eligibility, payer information, and demographic errors in the EMR.
• Maintain a safe, secure, and healthy work environment by following standards, procedures, and legal regulations.
• Follow front office and clinic policies and procedures.
• Update job knowledge through educational opportunities and professional publications.
• Actively participate in staff meetings.
• Develop and maintain a tracking system for SFS applications and Medicaid applications.
• 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 HIPAA compliance 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, prioritizing individual patient needs.

Requirements

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

Skills

• Faith-based commitment to Hope’s mission as a ministry of God.
• Knowledge of CPT and ICD-10-CM coding.
• Proficiency in operating general office equipment (computers, calculators, copiers, fax machines, telephones).
• Strong interpersonal skills and ability to build relationships at all levels.
• Excellent written and verbal communication skills.
• Passion for community healthcare.
• Leadership, team-building, and organizational skills.
• Ability to maintain integrity in a fast-paced, high-demand environment.
• Ability to manage performance goals.
• Cultural competency to interact effectively with diverse ethnic backgrounds, ages, and lifestyles, including special populations.

Physical Demands

Occasional standing, walking, lifting, reaching, kneeling, bending, stooping, pushing, pulling, and lifting/moving up to 25 pounds. Frequent sitting. Requires manual dexterity, good near vision, and the ability to communicate effectively in person and by phone. Ability to travel to various locations.