Insurance Coordinator

1. Insurance Verification & Pre-Authorization

• Eligibility Checks: Verify patient insurance coverage, benefits, and co-pay requirements before appointments.
• Prior Authorization: Coordinate with physicians and insurance companies to obtain approvals for surgeries, diagnostic tests, and specialist referrals.
• Policy Interpretation: Explain complex insurance benefits, deductibles, and "out-of-network" implications to patients in plain language.

2. Claims Management & Billing

• Claim Submission: Review and submit claims
• Denial Management: Investigate rejected or denied claims, correct coding errors, and resubmit appeals to secure payment.
• Revenue Tracking: Monitor "Days in Accounts Receivable" (AR) to ensure the clinic maintains healthy cash flow.

3. Patient & Provider Liaison

• Financial Counseling: Assist patients in setting up payment plans for balances not covered by insurance.
• Clinical Collaboration: Work with doctors and nurses to ensure documentation supports the medical necessity required by insurers.
• Conflict Resolution: Act as a mediator when disputes arise between the insurance company and the patient regarding coverage.