Benefits Coordinator

The Position:

The successful candidate will excel at identifying, analyzing, and resolving insurance eligibility issues, as well as successfully submitting Prior Authorizations and routing their approvals and/or denials appropriately, Benefits Coordinator will be working with our Reimbursement, Commercial, and Finance teams to provide on-going insight and analytics on all medical insurance claims.

This is a remote position, the ideal candidate must be willing to work Pacific time zone hours. 

ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.

• Answering patient/doctor/hospital/lab/insurance company phone calls regarding accounts, and taking appropriate action.
• Calling insurance companies regarding eligibility and authorization.
• Correctly identifying insurance carrier for proper claims filing.
• Creating and maintaining spreadsheets.
• Reviewing and interpret explanation of benefits to determine contractual allowance.
• Utilizing payor websites to check claim status and contacting payors regarding outstanding accounts
• Efficiently and accurately submitting Prior Authorization requests to insurance carriers via paper request and/or electronically (Glidian).
• Ensuring accurate and timely billing entry is completed daily.
• Researching and monitoring specific billing issues, trends and potential risks based on current research and customer feedback.
• Researching and responding to Medicare, Medicaid and other Payer inquiries regarding billing issues and insurance updates.
• Reviewing and submitting accurate claims, re-submissions and claim review forms.
• Reviewing unpaid and/or denied claims, appeals and follow-up on accounts to zero status.
• Reviewing and evaluating patient demographics for appropriate handling to include initiating telephonic follow-up to appropriate parties to collect additional information required for account resolution and/or to confirm account, claim status and arrange payment.
• Verifying insurance/recipient eligibility on to Medicare, Medicaid and Private Insurer Payers.
• When requested, providing administrative support for department(s) including but not limited to performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks.

Who You Are:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• High School diploma, Certified Professional Coder or 2-year degree from an Accredited
• Medical Billing School preferred.
• 1+ year of direct verification and billing experience preferred.
• Familiarity with ICD and HCPC/CPT coding preferred.
• Familiarity with CMS 1500 claim form preferred.
• Use of personal computer, computer applications, and general office equipment including scanners.
• Ability to create and maintain spreadsheets.
• Experience in handling and expediting escalated issues, with follow up to the customer.
• Ability to quickly assess a situation and take appropriate actions to address customer needs and requests in a timely and efficient manner. Self-starter with the ability to work independently and effectively in a team environment.
• Strong, consistent work ethic with a keen attention to details and ability to focus on the big picture.
• Excellent written and verbal communication skills; must be able to communicate with confidence and tact across all levels within the company.
• Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills.
• Experience working in Salesforce and XIFIN

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