Patient Eligibility & Benefits Coordinator

MODENA

. Manage prior authorization and precertification workflows for applicable visits, testing, procedures, and treatments .

Posted 11/12/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $26 - $32 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing prior authorization workflows, including submission and follow-up processes, while ensuring compliance with payer requirements and maintaining accurate patient records. Proficient in utilizing EHR/practice management systems and payer portals to enhance operational efficiency and support revenue cycle management.

Highest-signal resume keywords

Prior Authorization ManagementInsurance VerificationPayer Portal ExperienceEHR/Practice Management SystemsAttention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior AuthorizationInsurance VerificationAuthorization SubmissionPayer Follow-UpEligibility VerificationDocumentation ManagementClaims ProcessingPatient AccessRevenue Cycle ManagementProblem-Solving

Soft Skills

OrganizationPersistenceProfessional CommunicationEmpathyAttention to Detail

Tools & Technologies

EHR SystemsPractice Management SystemsMicrosoft OfficePayer PortalsHigh-Volume Electronic Work Queues

Industry Keywords

Healthcare AdministrationMedical Prior AuthorizationsCommercial Insurance PlansGovernment Insurance PlansAmbulatory CareSpecialty Practice

About the role

Key responsibilities & impact

Manage prior authorization and precertification workflows for applicable visits, testing, procedures, and treatments
Identify payer requirements and required documentation
Prepare and submit authorization requests through payer portals or approved channels
Coordinate with clinical teams to obtain supporting information and follow up with payers until determination
Track pending requests, approvals, denials, expiration dates, authorized services, and visit limits
Pursue outstanding authorizations and escalate time-sensitive or complex cases
Research authorization denials, missing information, and discrepancies
Support corrections, resubmissions, and appeals with clinical or billing teams
Verify active insurance eligibility, coverage, network participation, and effective dates
Confirm and document copays, deductibles, coinsurance, visit limitations, and patient-responsibility details
Maintain patient demographics, insurance cards, subscriber details, coordination-of-benefits information, and authorization records in the EHR/practice management system
Review appointment schedules and authorization work queues to prioritize urgent cases and prevent care disruptions and avoidable claim denials
Communicate with patients, payers, Practice Managers, clinical teams, and Billing to resolve questions
Document payer interactions and follow-up actions
Maintain HIPAA compliance and accurate records
Monitor turnaround times, work-queue productivity, and recurring authorization issues to support process improvements
Report to the Director of Billing

Requirements

What you’ll need

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
Ability to manage multiple authorization deadlines and communicate professionally and empathetically
Experience in an ambulatory, multi-site, allergy, asthma, or specialty practice is a plus
Ability to stand, walk, and move throughout the clinic, if applicable, for extended periods
Ability to occasionally lift objects up to 25 lbs., bend, stoop, or reach as needed
Frequent use of hands and fingers for patient care and equipment operation
Normal or corrected vision and hearing
Ability to respond quickly in a fast-paced clinical environment, if applicable
Resume and cover letter submission required