INSURANCE COORDINATOR

Position Purpose

The Insurance Coordinator supports the daily operations of the Obstetrics and Gynecology (OBGYN) practice by coordinating insurance verification, eligibility, referrals, authorizations, and other insurance-related requirements to ensure patients receive timely access to care. This position works closely with the OBGYN provider, clinical staff, patients, and insurance companies to facilitate accurate and efficient reimbursement while providing excellent customer service.

The Insurance Coordinator is responsible for ensuring insurance information is accurately obtained and maintained, identifying coverage requirements prior to services, assisting with authorization and referral processes, and supporting the resolution of insurance-related issues. As part of a Federally Qualified Health Center (FQHC), the position will also support organizational policies and procedures related to patient eligibility, sliding fee discounts, and other applicable FQHC requirements.

Essential Duties and Responsibilities

• Verify patient insurance eligibility and benefits prior to scheduled services.
• Obtain and document accurate insurance information, including primary and secondary coverage.
• Identify copayments, deductibles, coinsurance, referral requirements, and authorization requirements.
• Obtain prior authorizations for procedures, diagnostic services, medications, and other services as required by insurance plans.
• Coordinate referrals and communicate referral requirements to patients, providers, and clinical staff.
• Assist with insurance-related needs specific to OBGYN services, including prenatal care, ultrasounds, procedures, and other specialty services.
• Review patient accounts for insurance-related issues and assist with correcting eligibility, authorization, or billing discrepancies.
• Communicate with insurance companies, managed care organizations, Medicaid, Medicare, and other payers as needed.
• Work with billing and clinical staff to resolve denied or rejected claims related to eligibility, referrals, authorizations, or other insurance requirements.
• Maintain accurate documentation of insurance verification, authorizations, referrals, and communications in the electronic health record and applicable systems.
• Assist patients with understanding insurance coverage, financial responsibilities, and available payment or assistance options.
• Assist with screening patients for applicable FQHC sliding fee discount program eligibility and ensure required documentation is obtained in accordance with organizational policy.
• Maintain confidentiality of patient information and comply with HIPAA, applicable federal and state regulations, payer requirements, and organizational policies.
• Monitor outstanding authorizations and referrals to help prevent delays in patient care.
• Communicate effectively with the OBGYN provider and clinical team regarding insurance or referral requirements that may impact patient care.
• Provide professional, compassionate, and culturally appropriate customer service to patients.
• Assist with registration, scheduling, or other front-office functions as needed.
• Participate in quality improvement activities and departmental initiatives.
• Maintain current knowledge of insurance plans, payer requirements, Medicaid/Medicare guidelines, and applicable FQHC requirements.
• Perform other duties as assigned.

REQUIRED QUALIFICATIONS: 

• High school diploma or equivalent.
• Previous experience in medical insurance verification, healthcare registration, medical billing, referrals, authorizations, or a related healthcare administrative role.
• Knowledge of health insurance terminology, eligibility, benefits, copayments, deductibles, and authorizations.
• Strong computer and data-entry skills.
• Excellent communication and customer service skills.
• Ability to maintain confidentiality and handle sensitive patient information.
• Ability to work effectively with patients, providers, insurance companies, and multidisciplinary healthcare teams.

PREFERRED QUALIFICATIONS:

• Experience working in an FQHC, community health center, or other outpatient healthcare setting.
• Experience working with an OBGYN provider or women's health practice.
• Knowledge of Medicaid, Medicare, managed care, and commercial insurance plans.
• Experience with electronic health records and practice management systems.
• Experience with insurance authorization and referral processes.
• Knowledge of FQHC billing, sliding fee discount programs, or other federally funded healthcare requirements.

SKILLS/ABILITIES: 

• Knowledge of insurance verification and authorization processes.
• Understanding of medical terminology, particularly related to women's health and OBGYN services.
• Ability to communicate effectively with patients regarding insurance and financial matters.
• Strong attention to detail and organizational skills.
• Ability to prioritize multiple tasks and meet deadlines.
• Ability to identify and resolve insurance-related issues.
• Ability to maintain accurate records and documentation.
• Ability to work independently while collaborating effectively with the healthcare team.
• Demonstrated commitment to providing respectful, patient-centered service.

Physical Requirements

• Ability to sit, stand, walk, bend, and reach as required to perform assigned duties.
• Ability to use a computer and other office equipment for extended periods.
• Ability to communicate effectively in person, by telephone, and electronically.