Patient Eligibility & Benefits Coordinator

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🔥 58 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $26 - $32 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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MODENA

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

👥 B2C

Healthcare • B2C

Modena is a regional healthcare provider focused on allergy, immunology and respiratory care. With multiple clinic locations across Southern California and Arizona, Modena Health offers diagnostic testing and specialized treatments for allergies, asthma, chronic sinusitis, nasal polyps, inflammatory/eosinophilic diseases, immune disorders and pediatric pulmonology. Services highlighted include oral immunotherapy (OIT), sublingual OIT, low-dose immunotherapy, allergy testing, blood testing, and ongoing patient support. The organization is led by founder Brian Modena, MD, MSc, and staffed by board-certified allergists/immunologists, pediatric specialists and respiratory clinicians; the practice also mentions involvement in clinical research and applications of AI, genetics and the microbiome to personalize care.

📋 Description

• 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

• 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

🏖️ Benefits

• Competitive compensation • Professional development opportunities • Medical, dental, and vision insurance for eligible full-time employees • 401(k) retirement plan with employer matching for eligible full-time employees • Paid time off (PTO) • Sick time • Floating holidays • Holiday pay • Supportive, mission-focused culture • Opportunity to shape the future of a thriving allergy and asthma practice

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