WHAT DOES AN INSURANCE COORDINATOR DO?
Published: Sep 25, 2025 - The Insurance Coordinator confirms insurance coverage, submits claims, and follows up on payments to ensure timely reimbursement. This role handles patient billing concerns, maintains accurate financial records, and collaborates with healthcare teams to verify authorizations and benefits. The coordinator also ensures compliance with regulations and supports daily administrative functions through organized and effective communication.
A Review of Professional Skills and Functions for Insurance Coordinator
1. Insurance Coordinator Duties
- Billing Support: Assist with billing and patient treatment plans
- Insurance Procedures: Establish and verify insurance procedures with staff
- Contract Management: Add new PPO contracts, verify the schedule and attach accordingly
- Network Tracking: Track when each network is to be renegotiated and inquire as to progress
- Software Updates: Change in Improvis (Dental Software) as updates are available
- Data Analysis: Provide data to determine the effectiveness of a network
- Doctor Onboarding: Add new doctors to all contracts and complete all necessary paperwork
- Doctor Updates: Notify all insurance companies and complete all necessary paperwork when doctors change locations
- Payor Liaison: Liason between insurance payors and dental offices
- Information Verification: Verify information received from the practice is correct
- Fee Entry: Enter all contracted fees, patient copay tables, percentages, maximums, deductibles, frequencies, and age limits
- Claims Submission: Implement electronic claims submission with all payors
- Team Support: Help support team members' questions about Improvis
- Team Training: Assist in the training of team members
- Training Materials: Create tools and training documents for the practice
- System Communication: Communicate with doctors and managers about what is needed in the system
- Code Management: Manage any ADA codes that should be considered for addition/deletion
- Code Entry: Determine proper ICD-9 and CPT codes for oral surgery and enter them into the system
- Quality Support: Help and support with various Quality Assurance (OSHA and HIPAA) and Training needs
2. Insurance Coordinator Details
- Process Mapping: Process maps/SOPs, e.g., for claims notification, premium payment, etc.
- Report Compilation: Compile recurring PPT reports based on PPT/Excel template and financial/Risk/activity data to be extracted from a variety of internal/external sources
- Receivables Analysis: Analysis of receivable position by country and follow-up with countries
- Workshop Coordination: Preparation and follow-up of recurring workshops with internal stakeholders to discuss item 2 above
- Eligibility Verification: Verifying insurance eligibility and benefits
- Payment Entry: Inputting insurance and patient payments
- Claims Follow-Up: Following up on non-paid insurance claims
- Billing Statements: Processing of monthly account billing statements
- Accounts Management: Manage past due accounts receivable
- Form Review: Review patient forms/questionnaires and input them on the computer
3. Rehabilitation Insurance Coordinator Responsibilities
- Coverage Verification: Verify insurance coverage and billing information for new PT, OT and SLP patients scheduled
- Preauthorization Coordination: Coordinate and work with third-party payers, the patient or the responsible party, to ensure all pre-authorizations are in place at the time of the patient’s appointment
- Coverage Explanation: Provide a written description to patients and therapists of the patient’s insurance coverage at the time of the patient’s appointment
- Patient Responsibility: Determine patient responsibility for non-covered procedures/therapies, deductibles, or co-insurance, based on insurance coverage
- Patient Counseling: Counsel patients regarding insurance coverage and/or responsibility for self-pay portions of their bill
- Benefit Access: Assist patients to obtain full access to health care benefits and contact information so the patient can contact their insurance payer and ensure maximum reimbursement to DHMC
- Insurance Communication: Answer patient insurance coverage questions utilizing good customer relationship skills and in a professional manner
- Financial Referral: Refer patients or families to the Patient and Financial Services contact
- Billing Coordination: Coordinate with therapists and patients to ensure correct billing
- Note Review: Review clinical notes to determine diagnosis and CPT codes
- Clinical Submission: Provide clinical information to insurance carriers to complete pre-certification or prior authorization requirements
- Denial Appeals: Assume responsibility for appealing pre-certification denials
- Database Maintenance: Maintain complex databases used to track patient insurance coverage
- System Proficiency: Perform assigned functions demonstrating proficiency in a variety of automation tools, including eDH scheduling, Excel, and web-based systems skills
- Process Improvement: Review and assess systems for efficiency and make suggestions for improvement
4. Insurance Coordinator Job Summary
- Payment Posting: Post insurance and patient payments
- Deposit Balancing: Balancing deposits, sending claims, and reconciling production
- Claim Submission: Submit dental and medical claims
- Treatment Billing: Posting treatment from hospital cases and billing insurance
- Claims Follow-Up: Follow-up on unpaid claims
- Call Handling: Answer incoming billing and insurance calls
- Receivables Management: Manage patient and insurance receivables
- Statement Processing: Send monthly statements to patients
- Fee Accuracy: Ensure all fee schedules and insurance breakdowns are entered accurately and updated annually
- Authorization Coordination: Coordination with the insurance companies and all other departments in the hospital for insurance authorizations and claims
- Authorization Tracking: Monitoring and follow-up on prior authorization for outpatient/inpatient services
- Claims Analysis: Analysis of claims before submission to Insurance Companies
- Complaint Handling: Manages complaints in coordination with the Supervisor/Department head
- Claim Reconciliation: Reconcile claims with insurance companies and coordinate with Finance
- Priority Setting: Anticipates and sets priorities to support department needs and follow policies and procedures for achieving them
5. Insurance Coordinator Accountabilities
- Denial Resolution: Research, follow up, and resolve issues anytime there is a denial or partial payment made
- Staff Training: Train employees within the department on proper procedures for filing all types of insurance claims
- Certification Management: Ensure proper certifications, licenses, etc., are obtained or renewed
- Payment Posting: Receive and Post Payments received from insurance carriers
- Claims Support: Research and resolve issues with patients and insurance companies regarding claims
- Sales Posting: Post Sales and Cash Receipts for retail stores
- Statement Sending: Send Monthly Statements for balance dues
- Recall Management: Send out Monthly Recall Cards
- A/R Collections: Work on Retail, Dr., and Medicaid A/R Balances and send to collections promptly
- Claim Filing: File OH lab Medicaid claims
- Report Preparation: Prepare all Medicaid usage reports, either monthly or quarterly
- Lab Assistance: Assist with other Lab Medicaid accounts
- Internal Communication: Communicate with Doctors and Retail Employees on questions, paperwork, mistakes, etc.
- Filing Oversight: Ensure proper insurance filing process, monitor the process, and resolve routine problems