Healthcare Accounts Receivable & Insurance Follow-Up Specialist

Healthcare Accounts Receivable & Insurance Follow-Up Specialist

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 7.5% of annual pay for your 401K. Generous paid time off plus 8 paid holidays! 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 2020-2024!

Our Values: Patient-centered I Accountability I Respect I Innovation I Data-Driven

Our Mission: Igniting hope and healing for people with kidney disease through compassionate, innovative care.

Work Location: Hybrid

Works out of our Hazard Way office in San Diego, CA.

Eligible for hybrid schedule upon successful completion of onboarding/training.

Employee must reside within San Diego County, California.

Position Summary:

The Healthcare Accounts Receivable & Insurance Follow-Up Specialist is responsible for managing and resolving outstanding insurance and patient accounts to maximize reimbursement and reduce accounts receivable aging. This role performs comprehensive claim follow-up, denial resolution, appeals management, payment research, and account reconciliation while maintaining compliance with payer, regulatory, and organizational requirements.

Essential Duties and Responsibilities:

• Completes efficient and appropriate follow up activities on outstanding Medical A/R as assigned following procedures
• Contacts patients to follow up on outstanding self-pay balances, take payments, setup payment plans and/or initiate financial assistance
• Submits effective appeals resulting in higher propensity to pay
• Submits and/or attaches correct medical documentation to support prompt payment of claims based on payor requirements
• Works assigned charge review and claim edits accordingly
• Promptly responds to billing inquiries from patients, insurance companies and clinics in order to resolve account/claim issues while providing outstanding service
• Provides outstanding customer service when answering patient billing questions via inbound calls
• Identifies issues impacting quality and timely reimbursement and proposes potential solutions
• Exceeds 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
• Other duties as assigned.

Required Qualifications:

• 2 or more years recent professional medical billing/collection experience for a physician practice.
• Knowledge of medical terminology and CPT/HCPS codes and modifiers
• Demonstrated knowledge of medical terminology, CPT, HCPCS, ICD-10 and modifier codes, including impact on coverage and reimbursement.
• Knowledge of collection processes and collection laws.
• Vast payor experience including Medicare, Medi-Cal, HMO, FFS, PPO and IPA's.
• Strong proficiency with Microsoft Windows (ability to navigate, create and rename folders, save and organize files), Strong proficiency with Microsoft Office products (Outlook, OneNote, Teams, Excel, Word), proficiency with Adobe PDF. Ability to type 30 words per minute.
• Reside within San Diego County, CA

Preferred Qualifications:

• Proficient with the Epic billing system
• Bilingual in English and Spanish
• Nephrology specific experience
• 3 or more years recent Medical A/R experience working denials and self-pay follow up.

Education Requirement:

• High School graduate required

Required Skills:

• 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 in emergency situations.
• Ability to establish and maintain effective working relationships with patients, medical staff, and coworkers.
• Ability to multitask and stay organized. Detail oriented and ability to prioritize work.

Other considerations:

• Background check required
• Travel to other sites located within San Diego County may be required
• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
• Supervisory duties No

This position is being handled internally. We are not accepting solicitations from external recruiters or staffing agencies at this time.

Language Skills

While performing duties, the employee is regularly required to talk, hear, read, write, type and respond in English and understand clinical/medical vocabulary written and spoken.

Vision Requirements

Vision requirements include close vision, ability to adjust focus, and see color.

Physical Demands

Physical requirements may vary slightly and should be reviewed with your manager. In general, this position requires the ability to lift up to 35 pounds unassisted; ability to stand for extended periods of time and to perform repetitive stooping, walking, stretching, reaching and some sitting; ability to use full range of body motions required to lift patients, wear a lead apron, and lift and move supplies. Must be able to safely ascend and descend stairs as a core part of the job, with or without reasonable accommodation, when no elevator or lift is present.

Work Environment

Job required tasks routinely involve a potential for mucous membrane or skin contact with blood, body fluids, tissues or potential spills or splashes. Use of appropriate personal protection measures is required for every healthcare provider in these positions. Require to routinely use standard office equipment such as laptop, computer, mouse, and photocopier.

About Balboa United

Beginning in 1973, Balboa has grown from two physicians to a comprehensive nephrology team of 52 board certified physicians and 8 advanced practitioners. On January 1, 2018, Balboa Nephrology Medical Group (BNMG) launched Balboa United, a full-service medical practice management services organization. From one small office, BNMG now has 24 clinical offices throughout San Diego, Imperial, Orange and Riverside counties. In addition to office and hospital-based patient care, Balboa physicians manage the dialysis treatments of approximately 4,500 patients at 88 dialysis centers and conduct Nephrology based clinical research at 6 centers throughout Imperial and San Diego counties (California Institute of Renal Research).

EEO Statement Balboa United is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available person in every job. Our Company policy prohibits unlawful discrimination based on race, color, creed, religion (including religious dress & grooming), sex (including pregnancy, childbirth or related medical conditions), gender (including gender identity and gender expression), marital status, registered domestic partner status, military status, age, national origin or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), genetic information, sexual orientation, or any other basis protected by applicable federal, state, or local law. We also prohibit unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics. The Company is committed to compliance with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in our operations and prohibits unlawful discrimination by any employee of Balboa United, including managers and co-workers. If you believe you have been subjected to any form of unlawful discrimination, submit a written complaint to your manager or Human Resources (HR). Your complaint should be specific and should include the names of the individuals involved and the names of any witnesses. If you need assistance with your complaint, or if you prefer to make a complaint in person, contact the Company's Human Resources Department. We will immediately undertake an effective, thorough, and objective investigation and attempt to resolve the situation.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.