Insurance Coordinator

MISSION, VISION, AND VALUES

Our mission is to provide quality, comprehensive healthcare and supportive services to our community. Our vision is “Improving the Health and Well-Being of Our Community.” Our core values are Integrity, Compassion, and Excellence. Employees are expected to demonstrate a strong commitment to the mission, policies, goals, and philosophy of Harbor Community Health Centers.

JOB SUMMARY

Reporting to the Revenue Cycle Manager (RCM), the Insurance Coordinator plays a critical role in ensuring smooth and timely access to HarborCHC services by managing patient insurance verification and eligibility. Working closely with front office, enrollment, and billing staff, the Insurance Coordinator is responsible for verifying insurance benefits and eligibility for scheduled patients, troubleshooting issues, and educating patients and staff on public and private insurance programs. This role requires a keen attention to detail, strong communication skills, and a thorough understanding of insurance policies and procedures.

ESSENTIAL DUTIES & RESPONSIBILITIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

An individual must be able to perform each essential duty satisfactorily to be successful in this role. The requirements below represent the knowledge, skills, and abilities needed for the position.

Insurance Verification :

• Verify patient insurance coverage prior to appointments by contacting insurance companies and/or utilizing electronic verification tools to ensure correct benefits are in place for services to be rendered.

• Review and interpret insurance policy documents to determine patient eligibility and benefit details.

• Work with patients to gather insurance information and update records as needed.

• Confirm eligibility for Medicaid, Medicare, private, and other insurance plans.

Troubleshooting Insurance Issues :

• Investigate and resolve insurance-related issues, such as out-of-network, non-coverage of services, etc.

• Serve as the liaison between the patient, the healthcare provider, and the insurance company to resolve issues in a timely manner.

• Identify and address gaps in coverage and connect patients with an enrollment specialist if needed.

Patient Communication:

• Communicate with patients to explain insurance benefits, coverage limitations, and out-of-pocket costs.

• Address patient inquiries related to insurance benefits and resolve any issues or concerns.

• Educate patients on co-pays, deductibles, and other out-of-pocket costs.

Administrative Duties:

• Maintain up-to-date records of insurance verification and authorizations in electronic health record (EHR) system.

• Document all interactions and verification details in EHR for future reference and audit purposes.

• Ensure timely follow-up on pending insurance verifications.

• Collaborate with billing staff to ensure accurate submission of claims.

Collaboration and Compliance :

• Work closely with billing department, front office staff, and enrollment specialists to streamline the insurance verification process.

• Serve as the primary point of contact for insurance-related inquiries from staff; provide training and support to staff on insurance-related topics and procedures.

• Participate in training and professional development opportunities to maintain up-to-date knowledge.

• Provide feedback and recommendations for process improvements based on findings.

• Ensure compliance with FQHC and insurance regulations, maintaining a high level of accuracy and patient confidentiality.

QUALIFICATIONS

These specifications are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this job. Individual abilities may result in some deviation from these guidelines. To perform effectively in this position, the incumbent must have:

Education:

• High school diploma or equivalent required

• Associate’s or Bachelor’s degree in a related field preferred.

Experience:

Minimum of four (4) years of experience in insurance verification and medical billing in a healthcare setting is required. Prior work experience at a federally qualified health center (FQHC) preferred.

Skills and Attributes:

• Detail-oriented with strong organizational and analytical abilities.

• Bilingual in English and Spanish required.

• Must demonstrate good attendance and punctuality and complete all assignments timely.

• Strong knowledge of Medi-Cal, Medicare, Family PACT, CPE, PE4PP, Covered California and Sliding Fee Scale programs.

• Proficiency in medical terminology, billing codes, and insurance procedures.

• Proficiency in using EHR and practice management software, eClinicalWorks a plus.

• Proficient in the use of Microsoft Office programs (Outlook, Word, Excel, PowerPoint)

• Excellent communication and interpersonal skills, with the ability to explain complex insurance information to patients.

• Strong problem-solving and multitasking abilities.

• Ability to handle sensitive and confidential information with discretion.

EXPECTATIONS

• Adheres to all HarborCHC policies and procedures.

• Demonstrates HarborCHC’s core values of Integrity, Compassion, and Excellence at all times.

• Maintains a strong commitment to the mission, policies, goals, and philosophy of HarborCHC.

• Maintains a positive and respectful attitude in all work-related interactions.

• Communicates regularly with their immediate supervisor regarding departmental and organizational matters.

• Reports to work consistently and prepared to perform the duties of the position.

• Meets productivity standards and performs duties as workload requires.

• Maintains strict confidentiality of all data and information.

• Demonstrates integrity and accountability in all duties and responsibilities.

• Performs all job functions in a professional and courteous manner, including responding to phone calls and emails in a timely manner.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. While performing the duties of this job, the employee is regularly required to sit; use hands to manipulate objects, tools or controls; reach with hands and arms; and talk and hear. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust.

HOURS OF OPERATIONS

HarborCHC is open Monday-Thursday 7:00am-7:00pm, Friday 8:00 am-5:00pm, and Saturday 8:00am-5:00pm.

HR PROCEDURAL REQUIREMENTS

• Must be legally authorized to work in the United States

• Must successfully complete post-offer background screening and verification requirements

• This job description is not intended to be all-inclusive; additional duties may be assigned

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT

HarborCHC does not discriminate in employment opportunities or practices on the basis of race; religion; color; sex/gender (including pregnancy, childbirth, breastfeeding or related medical conditions); sexual orientation; national origin; ancestry; physical or mental disability; medical condition; genetic information/characteristics; marital status/registered domestic partner status; age; sexual orientation; reproductive health decision-making; military or veteran status; use of cannabis off the job and away from the workplace; and any other basis protected by federal, state or local law or ordinance or regulation, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. This policy applies whether the individual has or is perceived to have any of the characteristics protected by law or is associated with a person who has or is perceived to have any of the characteristics protected by law. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

DISCLAIMER

The above statements define this position as it currently exists and are intended to describe the general responsibilities and requirements for this job. They are not to be considered as an exhaustive statement of duties, responsibilities, or requirements and does not limit the assignment of additional duties at the discretion of the supervisor. HarborCHC is an at-will employer.

In addition, HarborCHC may change your duties, compensation or hours, or transfer, reassign, promote, demote, suspend, or otherwise change the terms and conditions of your employment (other than the at-will relationship), with or without cause or prior notice.