Medical Insurance Benefits Coordinator

hace 17 horas


Tijuana, Baja California, México Enovis México A tiempo completo
Job Summary

Patient Care Service Representatives at Enovis México work collaboratively with internal and external teams to seek benefit coverage for patients from insurance groups.

The role involves timely and compliant order entry, benefit verification, and prompt follow-up. This position requires strong communication skills, attention to detail, and a passion for patient care.

Key Responsibilities
  • Answers inbound and outbound calls to identify insurance and ensure compliant account resolution.
  • Verifies insurance eligibility and follows coordination of benefits guidelines.
  • Faxes accurate Pre-Authorization Request Letters.
  • Determines revenue amounts based on allowable, benefits, unit price, payer guidelines, copayment, and contract pricing.
  • Submits billing to Government entities and private insurance payers in compliance with Federal, State, and insurance requirements.
  • Pursues supporting documentation from Sales Teams to ensure invoicing accuracy.
  • Reviews prescriptions, Letters of Medical Necessity, and Chart Notes for completeness and accuracy.
  • Ensures orders meet criteria and compliance standards, resolves denials and variances by determining root causes and collaborating to reduce them.
  • Works to resolve submission issues by obtaining Medical Record documentation or validating coding.
Requirements and Skills
  • Advanced English verbal and written communication skills.
  • Minimum 2 years of experience in compliant patient billing, customer service, claims processing, or related experience in a healthcare environment.
  • Knowledge of ICD-10 coding, medical terminology, third-party billing, collections, and managed care requirements.
  • Strong attention to detail and passion for patient care and doing the right thing when decisions need to be made.
  • Full understanding of customer service and compliant insurance follow-up processes (Billing, Collections, Managed Care, Medicare, Medicaid, and Commercial payor practices).

We offer a competitive salary of $50,000 per year and an attractive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off. In-person work location available.



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