Insurance Eligibility and SFS Coordinator

JOB SUMMARY: The Insurance Eligibility and SFS Coordinator participate in the delivery of excellent medical services in a patient centered medical home environment with an emphasis on the prevention of disease. By thoroughly verifying patient insurance eligibility, determining Sliding Fee Scale eligibility and maintaining accurate patient demographic and insurance information to support timely access to care and accurate reimbursement. This position ensures compliance with payer requirements, ensures accurate data entry and maintains the confidentiality of patient information while providing excellent and affordable healthcare.

DUTIES AND RESPONSIBILITIES:

Insurance Eligibility and SFS Coordinator Duties

• Knowledge of medical insurance eligibility verification, payer guidelines, and coordination of benefits
• Understanding of Medicare, Medicaid, Managed Care, and commercial insurance plans.
• Ability to interpret Explanation of Benefits (EOB).
• Verifies patient identity, medical insurance, establishes if patient is eligible for Sliding Fee Scale to ensure each visit accurate completion.
• Reminds patients of upcoming appointments, follow-up visits, and referrals as applicable
• Always maintains and ensures patient confidentiality
• Updates the Electronic Medical Record (EMR) with accurate insurance information, demographic changes, primary care provider (PCP), co-pays, and coverage details. Corrects insurance entry errors that impact patient eligibility, laboratory billing, claims processing, and reimbursement.
• Ensures patient insurance coverage and eligibility accuracy to prevent claim denials.
• Provides accurate and detailed phone messages to other team members
• Obtains patient consent/signature(s) when necessary
• Reviews and reconciles Quest Diagnostics and LabCorp invoices for accuracy and completeness.
• Investigates and disputes Quest Diagnostics and LabCorp billing discrepancies, including duplicate charges, incorrect patient information, insurance billing errors, and coding issues.
• Research and corrects insurance eligibility, payer information, and demographic errors in the EMR to ensure accurate billing
• Maintains safe, secure, and healthy work environment by establishing and following standards and procedures; comply with legal regulations
• Ensures front office and clinic policies and procedures (as applicable) are always followed
• Updates job knowledge by participating in educational opportunities; reading professional publications
• Attends and actively participates in staff meetings
• Performs all other duties as assigned 

Administrative Duties

• Maintains customer confidence and protects operations by keeping sensitive information confidential and always maintaining patient confidentiality.
• Develops and maintains a tracking and dating system for SFS applications, number of patients apply for Medicaid.
• In conjunction with the accounting department, monitors and resolves financial discrepancies.

Other Duties:

• Promotes and demonstrates Hope values of: Gospel motivation, Prayer, Excellence, Stewardship, Patience, Thankfulness, Humility, Service, Dignity through Relationship and Hospitality and Joy 
• Always maintains a courteous and professional demeanor.
• Always maintains the confidentiality of Hope Christian Health Center finances and patient-related information.
• Performs all other duties as assigned 
• Uphold Complies with HIPAA and protects patient information.
• The Insurance Eligibility and SFS Coordinator ensures compliance with all 19 Health Resources and Services Administration (HRSA) Health Center Program Requirements.
• The Insurance Eligibility and SFS Coordinator is also expected to actively participate in and support quality improvement activities and the clinical practice team efforts emphasizing the importance of the individual patient and putting the patient’s needs first.

Qualifications:

• At least 1 (one) year of insurance verification in a medical clinic or facility - Required
• Fluency in English - Required
• Fluency in Spanish - Required

Education Required:

• High School Diploma or equivalent - Required

KEY COMPETENCIES FOR SUCCESS: 

• Faith to believe that Hope is a ministry of God, exemplifying the love of Christ, and held and directed by the Holy Spirit. 
• Knowledge of CPT and ICD-10-CM coding
• Ability to operate general office machinery (computers, calculators, copy/fax machine, telephones, etc.)
• Outstanding ability to build interpersonal relationships at all levels. 
• Excellent communication skills, both written and verbal. 
• Demonstrated passion for community health care. 
• Proven leadership, teambuilding, and organizational skills. 
• Proven ability to maintain integrity in a fast paced and high-demand environment. 
• Proven ability to manage performance goals. 
• Ability to interact with people from all ethnic backgrounds, ages, and lifestyles; ability to understand and respond appropriately, effectively, and sensitively to special populations 

TYPICAL PHYSICAL DEMANDS: 

Occasional standing, walking, lifting, reaching, kneeling, bending, stooping, pushing, pulling, and lifting and/or moving up to 25 pounds. Frequent sitting. Manual dexterity. Good reading eyesight and vision for close work. Ability to communicate by speaking and hearing in person or on the phone. Ability to travel to various locations.