Eligibility Coordinator

About Los Angeles Orthopedic Surgery Specialists 

Los Angeles Orthopedic Surgery Specialists provides compassionate, high-quality orthopedic care to help patients reach lifelong wellness. The experienced team of medical providers sees patients from in and around Los Angeles, with offices in East Los Angeles, Wilshire, Santa Fe Springs, Tarzana, Encino, Valencia, and Montebello, California.

The Benefits and Eligibility Coordinator is responsible for reviewing and verifying patients’ healthcare benefits and eligibility with insurance providers. This role ensures that patients are enrolled in the appropriate healthcare plans and that services are properly covered under their insurance policies. The coordinator will work closely with patients, insurance companies, and internal teams to resolve eligibility issues and provide accurate benefits information, ensuring that patients receive the necessary care without unnecessary delays or denials. Fluency in Spanish is required to effectively communicate with our diverse patient population.

Key Responsibilities:

1. Benefits Verification and Eligibility Review:
2. • Conduct benefit verification for patients to ensure they are eligible for services under their insurance plan.
   • Review and verify insurance coverage and benefits for scheduled appointments, procedures, and treatments.
   • Ensure that insurance plans cover the patient’s treatments and communicate any limitations or exclusions.
3. Insurance Liaison:
4. • Communicate directly with insurance companies and third-party payers to obtain accurate and timely benefits and eligibility information.
   • Work with insurers to resolve any discrepancies or issues related to benefits, coverage, and eligibility.
5. Patient Support:
6. • Provide clear and accurate information to patients about their benefits, coverage, and out-of-pocket responsibilities.
   • Assist patients in understanding their insurance benefits, including co-pays, deductibles, and out-of-pocket maximums.
   • Address any eligibility concerns or coverage issues to prevent delays in patient care and billing.
   • Provide bilingual (Spanish/English) support to patients to ensure they fully understand their benefits and eligibility information.
7. Claims and Authorizations:
8. • Ensure proper pre-authorization and prior-authorization processes are followed for required procedures or treatments.
   • Work with the clinical and billing teams to resolve issues related to claims denials and appeals due to eligibility or benefit errors.
9. Documentation and Record Keeping:
10. • Maintain accurate records of benefit and eligibility verifications, authorizations, and patient interactions.
    • Document all communications with patients, insurance providers, and internal staff regarding eligibility and benefits status.
    • Keep patient accounts updated with current eligibility and benefit information.
11. Collaboration and Coordination:
12. • Collaborate with clinical, billing, and administrative teams to ensure that patients are informed and care is not delayed due to insurance issues.
    • Work closely with financial counselors to provide patients with accurate estimates of costs based on their coverage.
13. Compliance and Quality Assurance:
14. • Ensure that all eligibility verification processes comply with healthcare regulations, including HIPAA, insurance industry standards, and payer-specific requirements.
    • Monitor and track benefit verification performance to identify any patterns that may require process improvement.
15. Problem Resolution:
16. • Proactively identify and resolve any patient eligibility issues, including insurance non-coverage, benefit discrepancies, or changes in patient insurance status.
    • Provide support in resolving appeals for denied claims related to eligibility and benefits.

Qualifications:

• Education:
• • High School diploma or equivalent; Associate’s degree in healthcare