Patient Eligibility & Benefits Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee prior authorization and precertification processes for relevant visits, tests, procedures, and treatments.

• Determine payer requirements and the necessary documentation.

• Prepare and submit authorization requests via payer portals or other approved methods.

• Collaborate with clinical teams to gather supporting information and follow up with payers until a determination is made.

• Monitor pending requests, approvals, denials, expiration dates, authorized services, and visit limitations.

• Actively pursue outstanding authorizations and escalate urgent or complex cases.

• Investigate authorization denials, missing information, and inconsistencies.

• Assist with corrections, resubmissions, and appeals in coordination with clinical or billing teams.

• Verify current insurance eligibility, coverage, network participation, and effective dates.

• Confirm and document copays, deductibles, coinsurance, visit limitations, and patient responsibility details.

• Maintain patient demographics, insurance cards, subscriber information, coordination-of-benefits details, and authorization records in the EHR/practice management system.

• Review appointment schedules and authorization work queues to prioritize urgent cases, preventing care interruptions and avoidable claim denials.

• Communicate with patients, payers, Practice Managers, clinical teams, and Billing to address inquiries.

• Document interactions with payers and subsequent follow-up actions.

• Ensure HIPAA compliance and maintain accurate records.

• Monitor turnaround times, work-queue productivity, and recurring authorization issues to facilitate process improvements.

• Report directly to the Director of Billing.

⛳️ Requirements

• A high school diploma or equivalent is required.

• Additional coursework or training in healthcare administration is preferred.

• A minimum of 1 year of experience in medical prior authorizations, insurance verification, patient access, or the healthcare revenue cycle is preferred.

• Hands-on experience with authorization submissions and payer follow-ups is strongly preferred.

• Familiarity with prior authorization and precertification requirements, payer portals, referrals, commercial and government insurance plans, eligibility, and benefits terminology is essential.

• Proficiency in using payer portals, EHR/practice management systems, Microsoft Office, and managing high-volume electronic work queues.

• Experience with ModMed is a plus.

• Exceptional attention to detail, organizational skills, persistence in payer follow-ups, and problem-solving abilities.

• Capability to manage multiple authorization deadlines while communicating professionally and empathetically.

• Experience in an ambulatory, multi-site, allergy, asthma, or specialty practice is advantageous.

• Ability to stand, walk, and move throughout the clinic, if applicable, for extended periods.

• Capability to occasionally lift objects up to 25 lbs., bend, stoop, or reach as necessary.

• Frequent use of hands and fingers for patient care and equipment operation.

• Normal or corrected vision and hearing.

• Ability to respond promptly in a fast-paced clinical environment, if applicable.

• Submission of a resume and cover letter is required.

🏝️ Benefits

• Competitive compensation package.

• Opportunities for professional development.

• Medical, dental, and vision insurance for eligible full-time employees.

• 401(k) retirement plan with employer matching for eligible full-time employees.

• Paid time off (PTO).

• Sick leave.

• Floating holidays.

• Holiday pay.

• Supportive, mission-driven culture.

• Opportunity to influence the future of a successful allergy and asthma practice.