Medical Billing Eligibility and Authorization Coordinator

POSITION SUMMARY :

The Medical Billing and Eligibility and Authorization Coordinator is a key position in the Revenue Cycle, responsible for managing the claims process, including accurate and timely claim creation, follow-up, and correspondence with providers and insurance companies. The role involves assisting in process improvements, ensuring payments from all sources are recorded and reconciled to maximize revenue, and handling credentialing, enrollment, and reporting for the San Diego Cardiac Center (SDCC).

PRIMARY DUTIES AND RESPONSIBILITIES :

• Coordinate patient eligibility verification through various sources.
• Work with reception staff to ensure proper collection of copays, spend-downs, and self-pay fees.
• Handle inquiries and provide answers to patients, clinic staff, and insurance companies.
• Resolve patient issues related to referrals, authorizations, and eligibility.
• Manage eligibility denials with insurance companies and patients.
• Communicate problems to supervisors or managers.
• Maintain confidentiality and adhere to HIPAA guidelines.

Other Miscellaneous and Related Tasks :

• Respond to questions regarding eligibility, authorizations, and referral procedures from management or staff.
• Obtain necessary authorizations and referrals in a timely manner.
• Review appointment books to verify patient eligibility prior to visits.
• Input and verify demographic and insurance information accurately.
• Notify relevant departments when patient insurance is not contracted.
• Respond to emails and messages in the EHR (EPIC) system across departments.
• Serve as backup for eligibility, referral, and authorization team members.
• Collaborate with team members to assist where needed.
• Represent SDCC professionally and courteously on or off-site.
• Perform other duties as assigned.

CORE COMPETENCIES AND EXPECTATIONS :

• Answer questions related to eligibility, authorizations, and referrals.
• Obtain authorizations and referrals promptly.
• Verify patient eligibility using appointment schedules and insurance information.
• Input and verify demographic and insurance data accurately.
• Notify departments when insurance is not contracted.
• Respond to emails and messages throughout the day.
• Act as backup for team members in eligibility, referral, and authorization tasks.
• Demonstrate teamwork and professionalism.
• Perform other duties as needed.

WORKING ENVIRONMENT :

• Physical demands include sitting for long periods, standing, bending, and stooping.
• Travel between SDCC offices may be required.
• Reasonable accommodations are available for individuals with disabilities.

Working conditions involve functioning in a fast-paced, high-stress healthcare environment with multiple tasks and high traffic volume.