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About the Role

The Billing Coordinator is responsible for coordinating insurance authorizations and supporting the medical billing process to ensure timely patient access to care by obtaining required approvals for medications, procedures, diagnostic testing, and imaging studies. This role acts as a liaison between providers, patients, insurance companies, pharmacies, and healthcare facilities to ensure authorizations and billing processes are accurate and efficient.

Responsibilities

Obtain and coordinate prior authorizations for specialty medications, including high-cost injectable and chemotherapy medications.
Coordinate insurance authorizations for diagnostic testing, imaging studies, procedures, and other services requiring payer approval.
Verify patient insurance eligibility, benefits, and coverage.
Communicate with insurance companies, specialty pharmacies, hospitals, imaging centers, and physician offices regarding authorization requirements and claim status.
Collaborate with providers, nursing staff, and clinical teams to obtain necessary clinical documentation supporting authorization requests.
Document all authorization activity, payer communications, and patient interactions accurately within the electronic medical record (EPIC) and applicable systems.
Educate patients regarding insurance requirements, authorization status, financial responsibilities, and next steps in the treatment process.
Assist with medical billing functions, including claim review, denial follow-up, appeals, and resolution of billing issues.
Maintain current knowledge of payer guidelines, authorization requirements, and regulatory changes affecting reimbursement.
Ensure compliance with HIPAA, payer regulations, and organizational policies.
Prioritize workload effectively while managing multiple authorizations, billing tasks, and deadlines.
Participate in departmental meetings, trainings, and quality improvement initiatives.
Process forms and faxes in alignment with department standards.
Perform other duties as required.

Requirements

High school diploma or equivalent.
4+ years of relevant experience in a healthcare setting.
Demonstrated ability to prioritize work and communicate effectively.
Strong computer skills.
Demonstrated strong organizational and communication skills.
Excellent customer service skills.
Attention to detail.
Ability to manage multiple priorities in a fast-paced medical office.
Knowledge of medical terminology.
Knowledge of insurance regulations.
Knowledge of prior authorization processes.
Knowledge of medical billing practices.
Strong organizational skills.
Strong analytical skills.
Strong problem-solving skills.
Experience with insurance company rules and regulations preferred.
Medical Terminology strongly recommended.
Working knowledge of insurance plans.
Working knowledge of prior authorization processes.
Working knowledge of Medicare.
Working knowledge of Medicaid.
Working knowledge of commercial payer requirements.
Successful candidates might be required to undergo a background verification with an external vendor.

Skills

Prior authorization
Medical billing
Insurance verification
Communication
Organization
Customer service
Attention to detail
Problem-solving
HIPAA compliance
EPIC

Work Type

Full-Time

Experience Level

4+ years of relevant experience in a healthcare setting

Education Level

High school diploma or equivalent

Salary/Compensations

$20.00 - $28.00 Per Hour

Equal Opportunity

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.