Eligibility Coordinator

Medical Oncology Associates of San Diego is a proud partner of One Oncology's network of the nations leading oncology practices.

Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description:

The Eligibility Coordinator is responsible for ensuring patients meet insurance coverage and authorization requirements prior to office visits. This position serves as a liaison between patients, providers, payers, and internal teams to ensure office visits meet payer requirements and minimize avoidable claim denials.

Patient-Centered Care

MOASD is committed to delivering compassionate, coordinated, and patient-centered care. The Eligibility Coordinator supports this mission by proactively identifying and resolving insurance coverage, referral, and office visit authorization barriers before they impact patient care. Through accurate eligibility verification and collaboration with internal and external partners, this role helps ensure patients have timely access to scheduled services while minimizing avoidable delays and claim denials.

Key Areas of Responsibility:

Coverage Verification

· Verify active insurance coverage, effective dates, IPA assignment, and specialist copayment requirements prior to scheduled office visits.

· Update patient insurance information within applicable systems to ensure accurate claim submission.

· Identify coverage discrepancies and coordinate resolution prior to the patient's appointment.

Referrals & Office Visit Authorizations

· Verify office visit authorizations requirements.

· Submit and track office visit authorization and referral requests in accordance with payer requirements.

· Follow up with payers, IPAs, and referring offices to obtain required approvals prior to scheduled appointments.

· Document authorization status, referral information, and payer communications within designated systems.

Documentation & Denial Prevention

· Maintain accurate eligibility, referral, and authorization documentation to support clean claim submission.

· Provide supporting documentation to billing for claim appeals involving eligibility verification or office visit authorization determinations.

· Identify trends contributing to authorization or coverage-related denials and communicate findings to leadership.

Collaboration

· Collaborate with Financial Counselors, Authorization Specialists, Schedulers, Billing, and Clinical Teams to ensure patients meet payer requirements before services are rendered.

· Prioritizes work to ensure office visit coverage verification and authorization requirements are completed prior to scheduled appointments.

· Escalate eligibility and authorization barriers that may impact patient access or appointment scheduling.

· Ensure compliance with HIPAA regulations by safeguarding patient information during all stages of processing.

· Promote a positive, inclusive and supportive team culture across all teams, consistently demonstrating professionalism and integrity.

· Meets quality and productivity standards.

*This job description is not designed to cover an exhaustive list of duties. Other duties may be assigned

and activities may change any time with or without notice, as applicable. Furthermore, job descriptions

do not establish a contract or change the at-will nature of employment.

Experience, Qualifications, Education

· Minimum 1 year of experience in insurance verification, referrals, authorizations, revenue cycle, or medical office operations.

· Knowledge of insurance verification processes

· Knowledge of managed care referral and authorization processes

· Ability to multitask efficiently in a fast-paced environment and a capacity to handle high volumes while maintaining attention to detail.

· High School Diploma, required

Knowledge, Skills, and Abilities

· Excellent verbal and written communication skills.

· Proficiency in computer processing functions and other standard office equipment.

· Ability to effectively manage and prioritize multiple tasks.

· Ability to calmly and professionally resolve issues with diplomacy and tact.

· Ability to work independently with minimal supervision.

· Strong organizational skills.

· Visual acuity to read a computer screen and paper documents; close and distance vision, peripheral vision depth perception, ability to adjust focus.

· Hearing acuity to converse with staff and customers in person and by phone.

· Ability to stoop, bend, kneel, reach with hands, and lift and move 10 pounds on a regular basis, and up to 25 pounds occasionally; ability to sit for hours at a time.

Working Conditions:

This position functions indoors in a medical/business environment. Employee will be exposed to moderate noise levels and interruptions. Visual acuity to read and compute screen and paper documents; close and distance vision, peripheral vision depth perception, ability to adjust focus; hearing acuity to converse with staff and customers. Ability to sit for hours at a time. Employee will be exposed to moderate noise levels and interruptions.

Travel:

Travel between local offices when necessary.

Pay:

$21-$24