Insurance Eligibility and Authorization Coordinator
Type: Full-Time | Hybrid | M–F 8:30 AM – 5:00 PM
Compensation: $20.00–$22.00 per hour
Location: Positions available in Garden Grove, CA, or Oxnard, CA.
Qualifications:
High school diploma or equivalent; associate’s or bachelor’s degree in healthcare administration or related field preferred.
Previous experience in insurance eligibility verification, medical authorization, or medical billing is highly desirable.
Strong understanding of insurance policies, healthcare coverage, and medical terminology.
Excellent communication and customer service skills, with the ability to work effectively with patients, healthcare providers, and insurance representatives.
Attention to detail and organizational skills, with the ability to manage multiple tasks and deadlines.
Familiarity with healthcare management software and insurance portals.
Knowledge of HIPAA regulations and maintaining patient confidentiality.
Spanish-speaking preferred.
Job Summary:
The Insurance Eligibility and Authorization Coordinator is responsible for ensuring the timely and accurate verification of insurance eligibility, obtaining necessary authorizations for medical treatments, and managing all related documentation. This position plays a crucial role in facilitating smooth communication between healthcare providers, patients, and insurance companies to ensure proper coverage and approval for services.
Key Responsibilities:
Verify patient insurance eligibility through online portals, phone calls, or insurance provider websites to ensure coverage for proposed treatments or procedures.
Obtain pre-authorizations and prior approvals from insurance companies for medical services, ensuring compliance with insurance policies and provider protocols.
Work closely with physicians, clinical staff, and insurance representatives to ensure that the required documentation is submitted for authorization.
Follow up on pending authorizations, ensuring they are processed in a timely manner to avoid delays in patient care.
Maintain accurate and organized records of all authorization requests, approvals, denials, and appeals.
Communicate with patients to inform them about the status of their eligibility and authorization, including any insurance issues or additional requirements.
Process treatment reports and submit them to the appropriate insurance companies for claims processing and reimbursement.
Address and resolve any issues related to insurance coverage, including discrepancies in eligibility or authorization denials, working with patients and insurance providers as needed.
Assist in handling insurance appeals for denied authorizations or claims, providing necessary supporting documentation.
Stay updated on insurance policy changes, authorization requirements, and billing procedures to ensure compliance and accuracy in all tasks.
Coordinate with the billing department to ensure that insurance approvals are properly integrated into the claims submission process.
Maintain confidentiality of patient information and adhere to all HIPAA regulations.
Collaborate with billing and insurance departments to ensure correct processing of claims, billing issues, and insurance verifications.