Medical Insurance, Referral & Billing Coordinator - Part-Time Uplift Career center Tampa, FL Job Details Part-time From $19 an hour 10 hours ago Benefits Health insurance Qualifications Health insurance co-pays HIPAA compliance Overseeing health insurance pre-certification Commercial insurance knowledge Phone communication Medical office experience HIPAA Healthcare referral management Electronic health record (EHR) management for billing and coding Client referral services Medical billing and coding communication with insurance companies Policy verification in claims processing Medical explanation of benefits reviews Medical claims submission Health insurance referral requirements Clinical confidentiality policies Client interaction via phone calls Full Job Description Medical Insurance, Referral & Billing Coordinator Position Summary We are seeking an experienced, dependable, and highly organized Medical Insurance, Referral & Billing Coordinator to support our growing primary care practice. The ideal candidate has previous medical-office experience and is comfortable independently handling insurance eligibility verification, benefits verification, prior authorizations, referrals, payer portals, claims follow-up, and basic medical billing functions. We are looking for someone who takes ownership of assigned responsibilities, tracks outstanding items through completion, communicates effectively with insurance companies, patients, pharmacies, specialists, and other healthcare organizations, and requires minimal supervision. This position may offer opportunities for increased hours, responsibilities, and professional growth. Insurance Eligibility & Benefits Verification Verify insurance eligibility before scheduled patient visits. Confirm that insurance coverage is active for the patient's date of service. Verify patient demographics and insurance information for accuracy. Confirm applicable copays, deductibles, coinsurance, and other patient financial responsibilities when available. Determine whether the patient's insurance plan requires referrals or prior authorization for services. Verify whether the treating providers are participating with the patient's insurance plan when applicable. Identify insurance discrepancies before the patient's appointment whenever possible. Update insurance information within the practice-management system. Communicate relevant coverage or financial-responsibility information to front-desk staff and patients as appropriate. Prior Authorizations Complete and track prior authorizations for medications, diagnostic testing, imaging, procedures, and other services when required. Determine payer-specific authorization requirements. Navigate payer and insurance portals. Obtain and submit required clinical documentation. Communicate with insurance companies regarding pending authorizations. Track authorization requests until a determination is received. Document authorization numbers, effective dates, expiration dates, and other relevant information. Communicate authorization issues to patients, pharmacies, facilities, and the provider when appropriate. Escalate requests requiring clinical decision-making to the provider. Referral Coordination Process outgoing specialty referrals accurately and promptly. Determine insurance referral and authorization requirements. Identify participating specialists when required by the patient's insurance plan. Send appropriate clinical documentation, laboratory results, imaging, and other records. Communicate with specialist offices regarding referrals. Track outstanding referrals. Follow up when patients have not scheduled or completed recommended referrals. Obtain specialist consultation reports when appropriate. Maintain accurate referral documentation within the electronic health record. Help ensure referrals are appropriately completed and closed. Medical Billing & Claims Support Review patient demographic and insurance information before claim submission. Assist with preparation and submission of clean claims through the practice-management/clearinghouse workflow. Monitor claim status. Identify rejected claims and determine the reason for rejection. Correct administrative claim errors within the scope of the position. Resubmit corrected claims when appropriate. Follow up on unpaid or delayed claims. Assist with denial follow-up and payer communication. Review insurance correspondence, EOBs, and ERAs as appropriate. Assist with payment posting and reconciliation workflows as assigned. Identify claims requiring provider documentation, coding clarification, or additional records and communicate those needs promptly. Maintain organized documentation of billing follow-up. Help identify recurring claim problems and recommend workflow improvements. Clinical coding decisions remain the responsibility of the treating provider and/or qualified coding resources when appropriate. Administrative Responsibilities Maintain organized insurance, authorization, referral, and billing work queues. Document all significant payer and referral communications. Assist with medical-record requests related to insurance, claims, referrals, and authorizations. Coordinate closely with the receptionist and clinical staff. Maintain patient confidentiality and HIPAA compliance. Help develop efficient administrative workflows as the clinic grows. Provide the owner/provider with concise updates regarding unresolved or high-priority issues rather than requiring repeated follow-up. Community Outreach & Marketing Support When insurance, referral, authorization, and billing responsibilities are current, the coordinator may assist with: Building relationships with local specialists and healthcare organizations. Maintaining an updated community referral-resource directory. Introducing Uplift Community Health Center to appropriate healthcare and community referral partners. Assisting with community outreach events. Distributing approved clinic marketing materials. Assisting with approved social-media and Google Business updates. Tracking how new patients learned about us. Helping identify opportunities to increase community awareness and patient volume. Marketing and community outreach are secondary responsibilities. Insurance, referrals, prior authorizations, and billing remain the primary responsibilities of this position. Required Qualifications Previous experience in a physician office, primary care clinic, medical practice, or similar healthcare environment. Hands-on experience verifying medical insurance eligibility and benefits. Experience working with medical insurance companies and payer portals. Experience completing and tracking prior authorizations. Experience processing and tracking medical referrals. Familiarity with medical claims and billing workflows. Ability to understand common insurance terminology, including copay, deductible, coinsurance, authorization, referral, EOB, ERA, rejection, and denial. Strong telephone and professional communication skills. Strong organizational and follow-through skills. Ability to independently manage multiple outstanding tasks and deadlines. Ability to work with minimal supervision. Experience with electronic health record and/or practice-management systems. Understanding of HIPAA and patient confidentiality requirements. Preferred Qualifications Primary care experience. Experience with Medicare, Medicaid, and commercial insurance plans. Experience with medication and imaging prior authorizations. Experience with claim rejection and denial follow-up. Experience with clearinghouses and electronic claim submission. Experience with OptiMantra, Office Ally, or similar systems. Experience with referral coordination. Healthcare community-outreach or marketing experience is a plus. Schedule Approximately 20 hours per week. The position will generally work an alternate schedule from other clinic support staff to maximize administrative coverage. Some scheduled overlap may occur for communication, training, and workflow handoffs.

Pay:

From $19.00 per hour

Work Location:

In person