Patient Eligibility & Benefits Coordinator

Position Summary

Reporting to the Director of Billing, the Patient Eligibility & Benefits Coordinator plays a key role in securing, tracking, and resolving prior authorizations for patient services. The coordinator also verifies insurance eligibility and benefits, maintains accurate insurance information, and collaborates with payers and clinic teams to support timely patient care and clean claims.

Key Responsibilities

• Manage prior authorization and precertification workflows for applicable visits, testing, procedures, and treatments, including identifying payer requirements and required documentation.
• Prepare and submit authorization requests through payer portals or other approved channels; coordinate with clinical teams to obtain supporting information and follow up with payers until a determination is received.
• Track pending requests, approvals, denials, expiration dates, authorized services, and visit limits; proactively pursue outstanding authorizations and escalate time-sensitive or complex cases.
• Research authorization denials, missing information, and discrepancies; support corrections, resubmissions, and appeals in collaboration with the appropriate clinical or billing team.
• Verify active insurance eligibility, coverage, network participation, and effective dates for upcoming visits, testing, and treatments using payer portals, electronic tools, and telephone outreach.
• Confirm and document benefits such as copays, deductibles, coinsurance, visit limitations, and other patient-responsibility details when available.
• Accurately enter and maintain patient demographics, insurance cards, subscriber details, coordination-of-benefits information, and authorization records in the EHR/practice management system.
• Review upcoming appointment schedules and authorization work queues to prioritize urgent cases, communicate potential delays, and help prevent care disruptions and avoidable claim denials.
• Communicate with patients, payers, Practice Managers, clinical teams, and Billing to resolve eligibility and authorization questions; document payer interactions and follow-up actions clearly and promptly.
• Maintain HIPAA compliance and accurate records; monitor turnaround times, work-queue productivity, and recurring authorization issues to support process improvements.

Qualifications & Requirements

• High school diploma or equivalent required; additional healthcare administration coursework or training preferred.
• At least 1 year of experience in medical prior authorizations, insurance verification, patient access, or healthcare revenue cycle preferred; hands-on authorization submission and payer follow-up experience strongly preferred.
• Working knowledge of prior authorization and precertification requirements, payer portals, referrals, commercial and government insurance plans, eligibility, and benefits terminology.
• Comfort using payer portals, EHR/practice management systems, Microsoft Office, and high-volume electronic work queues; ModMed experience is a plus.
• Strong attention to detail, organization, persistence in payer follow-up, and problem-solving skills; able to manage multiple authorization deadlines and communicate professionally and empathetically.
• Experience in an ambulatory, multi-site, allergy, asthma, or specialty practice is a plus.

What Success Looks Like

Timely and accurate authorization submissions and follow-up; fewer avoidable authorization-related delays and denials; accurate eligibility and insurance records; clear communication with clinic teams; and consistent performance against quality and productivity expectations.

Compensation

$26-32/hour, based on experience and qualifications.