Medical Billing Eligibility and Authorization Coordinator

San Diego Cardiac Center Medical Group Inc; San Diego (CA); On-site; USD 30,000 - 41,000; Full time

Job summary

San Diego Cardiac Center is seeking a Medical Billing and Eligibility and Authorization Coordinator to manage the claims process, ensure timely claim creation, and communicate with providers, insurers, and patients. The role includes credentialing, enrollment processing, and reporting for the SDCC.

Key responsibilities include coordinating patient eligibility, collecting copays, handling inquiries, resolving eligibility issues, and ensuring compliance with HIPAA guidelines in a fast-paced

Qualifications

• Experience in medical billing and eligibility processes.
• Strong knowledge of HIPAA regulations and patient privacy requirements.
• Excellent communication and problem-solving skills.

Responsibilities

• Coordinate the process of patient eligibility through various sources.
• Work with reception staff to collect copays, spend down, and self-pay fees.
• Handle inquiries from patients, clinic staff and insurers.
• Identify and resolve eligibility, referral, and authorization issues.
• Manage eligibility denials with insurance and patients.
• Notify supervisors of problems and maintain HIPAA compliance.

Skills

Eligibility coordination

Insurance follow-up

HIPAA compliance

Customer service

Epic software

Tools

Epic Systems

Job description

POSITION SUMMARY:

As an internal and external client-facing professional, the Medical Billing and Eligibility and Authorization Coordinator is a key position in the Revenue Cycle, manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. The incumbent will assist in the clarification and development of process improvements and inquiries, assure payments related to patient services from all sources are recorded and reconciled timely in order to maximize revenues. Other important duties include credentialing, enrollment processing, and reporting for the San Diego Cardiac Center (SDCC).

PRIMARY DUTIES AND RESPONSIBILITIES:

The primary job functions required of our Medical Billing and Eligibility and Authorization Coordinator includes the following, but not limited to:

• Coordinate the process of patient eligibility through various sources
• Work with reception staff, ensure appropriate collection of copays, spend down and self-pay fees
• Handling inquiries and answers questions from patients, clinic staff and insurance companies
• Identify and resolves patient issues related to referrals, authorizations, and eligibility problems
• Handle eligibility denials with insurance and patients
• Communicate problems to the appropriate Supervisor or Manager
• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations

Other Miscellaneous and Related Tasks

• Answer any questions from management or co-workers with regards to eligibility, authorizations, and referrals procedures
• Obtain authorizations and referrals on office services in a timely manner
• Review appointment books prior to patients coming in to verify patient eligibility with contracted insurance carriers
• Input and verify correct demographic and insurance information for patients
• Notify participating departments in a timely manner when patients insurance is not contracted with practice
• Respond to email, EHR messages/tasks in Epic throughout the day for all departments
• Serve as back-up for team eligibility, referral, and authorization members
• Be a team player: Identify how you might assist fellow team members
• Always represent SDCC and its staff and Providers in a professional, courteous, and respectful manner on or off property
• Perform other duties as assigned or requested

CORE COMPENTENCIES AND EXPECTATIONS:

• Answer any questions from management or co-workers with regards to eligibility, authorizations, and referrals procedures
• Obtain authorizations and referrals for office services in a timely manner
• Review appointment books prior to patients coming in to verify patient eligibility with contracted insurance carriers
• Input and verify correct demographic and insurance information for patients
• Notify participating departments in a timely manner when patients' insurance is not contracted with the practice
• Respond to email, EHR messages/tasks throughout the day for all departments
• Serve as backup for team eligibility, referral, and authorization members
• Be a team player: Identify how you might assist fellow team members
• Always represent SDCC and its staff and Providers in a professional, courteous, and respectful manner on or off the property
• Perform other duties as assigned or requested

WORKING ENVIRONMENT:

• Physical demands:
  • The position may involve sitting for long periods of time, standing, bending, and stooping.
  • Responsibilities may also require the incumbent to travel between SDCC offices for support purposes.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions
• Working Conditions:
  • Ability to function in a fast-paced/high stress healthcare office environment, which may involve dealing with a high traffic volume of people and stressful situations requiring the ability to think clearly; respond quickly; and to be able to perform multiple tasks simultaneously.

San Diego Cardiac Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.