Patient Care Coordinator

EDGE is connecting top global talent with the US Healthcare and Insurance industry, aiming to build a borderless network centered around people. We are currently seeking a Patient Care Coordinator to support US-based healthcare providers. The ideal candidate will have experience in the US healthcare sector, particularly in scheduling, eligibility verification, prior authorizations, and insurance verification. This role is vital in bridging communication between patients, healthcare providers, and insurance companies. The successful candidate will be detail-oriented and tech-savvy, adept at navigating complex insurance portals and electronic health records to ensure patients receive timely care.

Key Responsibilities
- Conduct thorough eligibility checks and benefits verification for patients before their appointments.
- Interpret complex insurance policies, including PPO, HMO, and Medicare/Medicaid guidelines.
- Determine and document patient financial responsibilities such as deductibles, copays, and coinsurance within the practice management system.
- Prepare, compile, and submit prior authorization requests to insurance companies through web portals, fax, or phone.
- Review clinical documentation like progress notes, lab results, and physician orders to confirm medical necessity before submission.
- Monitor the status of pending authorizations, manage appeals for denied claims, and expedite urgent requests to avoid delays in patient care.
- Manage inbound and outbound patient calls to schedule, reschedule, and remind patients of wellness visits and routine check-ups.

Required Qualifications
- Minimum of one year of direct experience in the US healthcare industry, including scheduling, eligibility verification, prior authorizations, and insurance verification.
- Strong understanding of US insurance concepts such as PPO, HMO, Explanation of Benefits (EOBs), copays, and patient benefits eligibility.
- Proficiency in using insurance portals like Availity, Optum, Covermymeds, and electronic health record/practice management systems such as ECW, Tebra, or Dentrix.
- Exceptional attention to detail, strong analytical skills, and excellent written and verbal communication in English.
- Ability to work independently in a fast-paced environment.

Our Hiring Process
Candidates will undergo a multi-step process starting with an application review. Qualified applicants will be invited for an interview with an Edge representative to assess fit. Successful candidates will complete onboarding and training before participating in client interviews tailored to specific needs. Once matched, candidates join the Edge Global Talent Community, ready to contribute meaningfully to healthcare.

About EDGE
EDGE is committed to eliminating geographic barriers to employment by creating a global hiring network that connects exceptional talent worldwide with North American businesses. Our Talent Network fosters a community where professionals can unlock their potential, showcase their skills, and earn competitive wages.

Equal Opportunity Employer Statement
EDGE is proud to be an equal opportunity employer dedicated to fostering diversity and inclusion. All qualified applicants will receive consideration without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, disability, age, veteran status, or any other protected status.

Candidates interested in accelerating their application process are encouraged to create a profile on our talent platform.