Insurance Authorization Specialist

Overview

Balboa Nephrology is the largest kidney care practice in California and participates in a national Medicare program focused on value-based care. Through our joint venture with Evergreen Nephrology we are a growing organization with opportunities for professional and personal growth. We will help you grow in your leadership experiences while learning the new value-based care world.

Comprehensive benefits package that includes medical, dental & vision on the 1st of the month 30 days after hire. Employer contribution of up to 10% of annual pay for your 401K. Generous paid time off plus 8 paid holidays, a birthday float day off and a mental health day!

Company paid life insurance. Join a fast-growing field - employment of medical and health services managers is projected to grow 32 percent from 2020 to 2030, much faster than the average for all occupations. Voted 4 years in a row as a Top Workplace of San Diego !

Patient-centered I Accountability I Respect I Innovation I Data-Driven

to consistently deliver superior care – Balboa Care – to every patient with kidney disease.

Pay Range: $22-25 per hour based on experience, eligible for revenue cycle bonus incentive.

Location:

Works out of business office on Hazard Way in San Diego, CA. Eligible for hybrid schedule upon successful completion of training.

The Insurance Authorization Specialist is responsible for ensuring correct insurance registration setup, verification of coverage and eligibility, and obtaining appropriate authorizations. The specialist works to ensure patients have a smooth check-in process by finalizing all insurance items prior to appointments to ensure claims are processed and paid as authorized by timely working items in work queues, following up with payors, internal teams, and patients.

• Completes timely, efficient, and appropriate insurance registration, verification of coverage and eligibility, and obtains authorizations following payer and internal procedures with minimal supervision.
• Updates registration and coverage at the account and visit level as necessary to prevent denials.
• Ensures copays are updated for non RTE payors and escalates RTE copays that are incorrect to leadership.
• Contacts patients for updated insurance information.
• Promptly and accurately responds to inquiries from patients, payers, and internal customers.
• Continuously identifies issues and trends impacting patient care, quality, and timely reimbursement and reports to leadership along with potential solutions.
• Meets quality and productivity standards.
• Supports and actively participates in process improvement initiatives.
• Assists with other duties to support the revenue cycle process and Balboa’s core values as assigned.

• 1 year recent experience performing insurance registration, coverage and eligibility verification, and obtaining authorizations in a medical environment or recent completion of medical billing program and equivalent experience.
• Understanding of revenue cycle process, vast understanding of different coverages and payors including Independent Practice Associations (IPAs), and authorization process.
• Strong proficiency with Microsoft Windows (navigate, create and rename folders, save and organize files), Microsoft Office products (Outlook, One Note, Teams, Excel, Word), and Adobe PDF. Ability to type 30 words per minute.
• Dedicated HIPAA compliant and ergonomic workspace with ability to work uninterrupted while working remotely, with high-speed internet meeting minimum speed requirements.

• 3 years recent experience performing insurance registration, coverage and eligibility verification, and obtaining authorizations in a medical practice environment.
• Epic EHR experience.
• Bilingual in Spanish.
• Nephrology experience.

• High School graduate or equivalent required

• Excellent verbal and written communication.
• Ability to provide excellent customer service.
• Ability to interpret, adapt and apply guidelines and procedures.
• Ability to use good reasoning and judgement and react appropriately…