Department: Non-Clinical Staff
Reports To: Practice Administrator
Location: Brockton, MA
Pay Status: Full Time, Hourly, Non-Exempt
The Patient and Insurance Coordinator is responsible for providing exceptional patient service while coordinating the administrative and insurance-related activities necessary to support timely and efficient patient care. This position serves as an initial point of contact for patients and visitors and is responsible for patient scheduling, registration, insurance verification, referrals, prior authorizations, and coordination of required documentation.
Strong knowledge of health insurance processes is an essential component of this role. The Patient and Insurance Coordinator must have a thorough understanding of insurance eligibility, benefits, referrals, authorizations, payer requirements, and the ability to identify and resolve insurance-related issues that may delay or prevent patient care. The incumbent is expected to proactively identify potential insurance barriers and work with patients, insurance companies, referring offices, and clinical staff to resolve issues in a timely manner.
- Assist with front desk operations, including answering phones, greeting patients, updating demographics, handling check-in/check-out, and providing professional customer service.
- Schedule office visits, diagnostic testing, and procedures; coordinate follow-up care and identify missing requirements before appointments.
- Obtain and maintain medical records, referrals, authorizations, and other required documentation. Scan, fax, file, and maintain accurate patient records while ensuring HIPAA compliance.
- Perform other administrative duties as assigned by the Practice Administrator
- Verify eligibility and benefits, identify coverage requirements, obtain referrals and prior authorizations, and resolve payer issues.
- Communicate directly with insurance companies and referring offices to clarify benefits, obtain required information, and resolve authorization or coverage barriers that could delay patient care.
- Ensure insurance eligibility, referral, authorization, and documentation requirements are completed before scheduled services.
- Maintain accurate records of insurance verification, referrals, authorizations, and payer communications in the EMR.
- Assist patients with general insurance and financial-responsibility questions and escalate complex billing matters appropriately.
The incumbent must possess a minimum of a High School Diploma or equivalent and 1–2 years of medical office experience, preferably in a physician practice or specialty setting. Demonstrates knowledge and experience with health insurance eligibility, benefits verification, referrals, prior authorizations, and payer requirements is required.
Additional qualifications include:
- Strong understanding of medical insurance terminology, eligibility, benefits, referrals, authorizations, and coverage requirements.
- Ability to recognize and address insurance issues that may impact patient care.
- Strong attention to detail and accuracy, particularly when reviewing demographic, insurance, referral, and authorization information.
- Excellent organizational and time-management skills with the ability to prioritize multiple responsibilities and meet deadlines.
- Strong customer service skills and professional telephone etiquette.
- Ability to work effectively under pressure and handle difficult or sensitive situations professionally.
- Ability to work independently, take initiative, and follow through on outstanding issues.
- Working knowledge of EMRs, electronic insurance eligibility systems, email, Microsoft Office products, data entry, and other business office systems.
- Strong oral and written communication skills.
- Ability to work collaboratively as part of a team and support the goals and objectives of the Practice.
- Commitment to maintaining patient confidentiality and adhering to HIPAA regulations.
- Competitive Pay
- Medical, Dental and Vision Insurance
- Life/AD&D Insurance
- Long-Term and Short-Term Disability Insurance
- Flexible Spending Account
- Retirement Plan
- Paid Time Off and Paid Holidays
