Role Description

The RCM Insurance Coordinator plays a vital role in patient access and revenue cycle processes by ensuring all necessary financial and insurance-related clearances are obtained prior to scheduled medical services. This role supports operational efficiency, compliance with payer guidelines, and a seamless patient experience across National Spine & Pain Centers (NSPC).

• Verify patient insurance eligibility and benefits for scheduled services (inpatient, outpatient, diagnostic, and surgical).
• Obtain and document referrals from insurance carriers in accordance with payer requirements.
• Generate and communicate accurate patient cost estimates.
• Contact patients to review insurance benefits, financial responsibility, and available payment options.
• Collaborate with scheduling and clinical teams to resolve clearance issues (e.g., missing referrals, incorrect coverage).
• Maintain timely and accurate documentation in EMR and patient access systems.
• Monitor payer requirements to ensure compliance with organizational and regulatory guidelines.
• Escalate complex insurance or clearance issues as appropriate.
• Partner with financial counseling and billing teams to ensure a smooth patient experience.

This job description is a summary of the primary duties and responsibilities of the position. It is not intended to be a comprehensive listing of all duties and responsibilities. Contents are subject to change at management's discretion.

Qualifications

• High school diploma or equivalent required; Associate’s degree preferred.
• 1 year experience in eligibility and benefits review or related healthcare administration required; experience in pain management, orthopedics, neurology, or radiology preferred.
• Understanding of commercial insurance plans (HMO, PPO, POS, EPO) including eligibility, benefits, and prior authorizations.
• Knowledge of government payers including Medicare (Parts A–D, Medigap), Medicaid (state-specific programs, MCOs), and Workers’ Compensation.
• Familiarity with CPT, ICD-10 codes, and medical terminology preferred.
• Strong verbal and written communication skills.
• Excellent attention to detail and organizational abilities.
• Ability to manage high volumes in a fast-paced environment.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and payer portals for eligibility and benefits verification.

Working Conditions

• Remote position. Assigned duties will be performed in areas free from background noise and from distraction.
• Remote work area must protect the confidentiality of the work the employee is performing.
• Regular use of office equipment.

Physical Requirements

• Extensive and regular periods of sitting, standing, bending, walking, seeing, talking, and listening.
• A full range of body motion including complete manual and finger dexterity, as well as effective hand-eye coordination.
• Adequate visual acuity including ability to read information.
• An occasional requirement to reach with hands/arms, stoop, kneel, or crouch.
• An occasional requirement to push, pull, lift and/or move up to 10 pounds.