Health Insurance Eligibility Coordinator

**Job Title**: Health Insurance Eligibility Coordinator**Location**: Remote (Work from Home)**Hours**: Full-time, daytime hours based on Pacific Time (PST)**Job type**: Independent Contractor**Job Summary****Key Responsibilities**:- **Insurance Verification**:- Verify patient insurance eligibility for services and procedures by contacting insurance carriers or using online portals.- Determine co-pay, deductibles, and out-of-pocket costs based on patient’s insurance plan.- **Prior Authorizations**:- Obtain prior authorizations for procedures, surgeries, and other treatments as required by the patient’s insurance plan.- Ensure timely submission of prior authorization requests and follow up with insurance companies to avoid delays in patient care.- **Appeals and Denials**:- Analyze denied prior authorization requests, gather necessary documentation, and submit appeals within specified timelines.- Work closely with healthcare providers and insurance companies to collect required information for appeals.- Identify trends or areas for improvement in denials to help minimize future denials.- **Insurance Coverage Knowledge**:- Understanding of various health insurance policies, including private payers, Medicare, and Medicaid.- Working knowledge of medical terminology, **CPT codes**, and **ICD-10 codes** to ensure accurate communication and processing of claims.- **EMR Management (eClinicalWorks)**:- Accurately input and update patient insurance information in the Electronic Medical Records (EMR) system.- Maintain comprehensive patient records and ensure all insurance-related information is accurate and current.- **Patient & Insurance Company Communication**:- Communicate effectively with insurance company representatives regarding coverage, prior authorizations, and eligibility matters.- Provide clear and detailed information to patients regarding their insurance coverage, eligibility, and out-of-pocket expenses.- Address any questions or concerns from patients related to their insurance or financial responsibility.- **Collaboration**:- Work closely with clinical staff, billing departments, and external providers to coordinate patient care and ensure insurance-related matters are resolved in a timely manner.- Assist the billing team in resolving denied claims related to eligibility or prior authorizations.**Remote Work Requirements**:- Willingness to submit to IT security protocols and software installations as required by the company.- Ability to work independently while adhering to deadlines and guidelines.- Must provide a current National Background Investigation (NBI).**Qualifications**:- **Experience**:- Minimum of 2 years of experience in insurance verification, prior authorizations, or a similar role in a healthcare setting.- Experience working with health insurance coverage, including private plans, Medicare, and Medicaid/Medi-Cal- Strong working knowledge of EMR systems; experience with eClinicalWorks (eCW) is highly desirable.- **Skills**:- Fluent in written and spoken English.- Excellent organizational and multitasking skills.- Strong attention to detail, particularly when handling sensitive patient information.- Working knowledge of privacy US privacy regulations (HIPAA).- Strong communication skills, both verbal and written.- Ability to work independently and as part of a remote team.- **Technical Knowledge**:- Familiarity with insurance verification portals and prior authorization systems.**Preferred Qualifications**:- Prior experience in a medical office, hospital, or outpatient clinic setting.- Experience working in eClinicalWorks EMR system.- Familiarity with coding and billing processes related to insurance coverage.**Benefits**:- Very competitive pay.Pay: $18,000.00 - $32,000.00 per monthApplication Question(s):- Please name the EMR/EHR systems you have used on the job:- Are you willing to work daytime hours on Pacific time zone (Monday-Friday)?**Experience**:- insurance eligibility: 2 years (required)**Language**:- fluent English (required)License/Certification:- criminal background check (required)Work Location: RemoteApplication Deadline: 30/12/2024Expected Start Date: 10/03/2025