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Patient Benefits Coordinator

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Job Title:

Patient Benefits Coordinator

Job Purpose:

Under the direction of the Coding and Reimbursement Manager the role of this position is to manage all patient benefits and insurance verification while reviewing and communicating payor requirements.

Job Responsibilities:

• Verification of patients’ insurance eligibility and benefits
• Initiate PCP referrals
• Obtain necessary referrals, authorizations, pre-certifications, and/or pre-determinations for clinic services
• Review and resolve referral, authorization, pre-certification, and/or pre-determination issues
• Quarterly review of payor clinical and reimbursement policies pertaining to the services provided in the clinic
• Communicate payor requirements for referrals, authorizations, pre-certifications, pre-determinations to providers and staff as appropriate
• Performs other duties as required and in accordance with defined task-related responsibilities


• 2 or more years of experience in similar position
• Knowledge of government and commercial health insurance and reimbursement/billing requirements as they pertain to patient eligibility and benefits, authorizations, pre-certifications, pre-determinations
• Medical terminology and working knowledge of coding guidelines as it pertains to patient eligibility and benefits, authorizations, pre-certifications, pre-determinations
• Experience with electronic medical records and practice management systems (athenaClinicals a plus)
• Ability to navigate payor portals
• Proficient in Microsoft Office applications
• Bilingual preferred


• Detail oriented and highly organized with ability to meet scheduled deadlines
• Ability to work with limited direction
• Strong verbal and written communicate skills
• Professional appearance and demeanor
• Promptness and a positive attitude a must

FLSA Status: Non-Exempt Department: Billing
Reports To: Coding and Reimbursement Manager


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