Insurance Eligibility Coordinator

Essential Functions

• Verify patient insurance eligibility and benefits using electronic systems, payer portals, and direct insurance carrier communication.
• Accurate document coverage details, copayments, deductibles, prior authorization requirements, and plan limitations.
• Prepare and submit claims in a timely and accurate manner.
• Identify and correct rejected claims for prompt resubmission.
• Submit and follow up on authorization requests.
• Follow up on denied or unpaid claims and work to resolve discrepancies.
• Post payments and adjustments to patient accounts in a timely manner.
• Communicate with insurance companies and internal staff regarding billing inquiries or issues.
• Maintain up-to-date knowledge of payer rules, policy changes, and medical coverage guidelines.
• Protect patient privacy and maintain compliance with HIPAA and organizational standards.
• Support revenue cycle improvement initiatives related to eligibility and insurance workflows.
• Participate in team meetings and contribute to quality improvement initiatives.
• Adhere to practice policies, procedures, and protocols including confidentiality.

Qualities & Skills

• Strong understanding of insurance plans, terminology, HMOs, PPOs, Medicare/Medicaid and commercial payer policies in NJ, NY, & PA.
• Excellent communication, customer service, and problem-solving skills.
• Proficiency with medical practice management software, EHR systems, and payer portals.
• Ability to multitask and work in a fast-paced environment.
• Strong Knowledge of Microsoft Office Suite.
• Comfortable working independently and collaboratively.
• Outstanding problem solver and analytical thinking skills.
• Attention to detail and ability to prioritize.
• Ability to maintain confidentiality.
• Experience in Behavioral health is preferred.

Qualifications

• High School diploma or equivalent required.
• 1-2 years of experience in medical insurance verification, medical billing, or related roles.