Insurance Authorization Specialist

Insurance Authorization Specialist

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 workqueues, following up with payors, internal teams, and patients.

Essential Duties and Responsibilities

• 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.

Required Qualifications

• 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 (IPA's), and authorization process.
• 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.
• Dedicated HIPPA complaint and ergonomic workspace with ability to work uninterrupted while working remotely, with high-speed internet meeting minimum speed requirements.

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

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.