Virtual Insurance Professional

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 include completing timely, efficient, and appropriate insurance registration, verification of coverage and eligibility, and obtaining 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 include 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.