•ONLY experienced medical insurance specialist apply

Job Type:

Full-time Location:

Simi Valley, CA About the Position Join an established, patient-centered cardiology practice where your work will make a direct difference in patients' ability to access timely cardiovascular care. We are seeking an experienced, highly organized Insurance Specialist to serve as a key liaison among patients, insurance plans, and our clinical and administrative teams. This is an important role for someone who understands the urgency, complexity, and detail required in benefits verification, eligibility, prior authorizations, billing, and denial resolution. The ideal candidate is proactive, persistent, accurate, and comfortable managing multiple payer requirements while maintaining professional and compassionate communication with patients. Responsibilities Benefits and Eligibility Verify active insurance coverage, eligibility, benefits, network status, referral requirements, and patient financial responsibility before scheduled visits, diagnostic testing, procedures, and services. Review benefits for copays, deductibles, coinsurance, out-of-pocket requirements, and coverage limitations. Identify insurance discrepancies or coverage concerns promptly and communicate necessary information to patients and the practice team. Maintain accurate patient insurance information in the electronic health record and practice management system. Prior Authorizations and Referrals Initiate, submit, track, and follow up on prior authorization requests for cardiology office visits, diagnostic testing, imaging, procedures, and prescribed medications. Communicate with insurance plans, utilization-management departments, patients, providers, and external facilities regarding authorization requirements and status. Track authorization numbers, approval dates, expiration dates, denials, and required follow-up to prevent delays in patient care. Prepare and submit supporting clinical documentation for authorization requests under provider direction. Identify denied or pending requests promptly and coordinate next steps, including requests for additional information, appeals, and peer-to-peer reviews as directed by the provider. Billing and Claim Follow-Up Assist with medical billing workflows, including claim review, charge capture support, payment posting coordination, and account follow-up. Review claim denials, rejections, and underpayments; identify root causes and take appropriate action for correction, resubmission, appeal, or follow-up. Communicate with insurance carriers to resolve payer issues, claim-status questions, and billing discrepancies. Work collaboratively with the billing team to improve clean-claim submission and reduce preventable denials. Maintain accurate documentation of insurance communications, authorization activity, billing follow-up, and claim-resolution efforts. Qualifications High school diploma or equivalent required; associate degree, medical billing certification, or related training preferred. Minimum [2] years of recent experience in a medical office insurance, billing, authorization, benefits, eligibility, or revenue-cycle role required. Demonstrated experience verifying insurance eligibility and benefits, obtaining prior authorizations, and resolving insurance-related issues. Experience with medical billing, claim denials, appeals, payment posting, and accounts receivable follow-up preferred. Knowledge of commercial insurance, Medicare, Medicare Advantage, managed-care plans, and payer portal systems preferred. Proficiency with electronic health records, practice management systems, insurance websites, and Microsoft Office. Excellent attention to detail, organization, problem-solving, follow-through, and written and verbal communication skills. Ability to prioritize competing tasks, meet deadlines, and work effectively in a fast-paced team environment. Benefits [Paid time off] [Other benefits]

To Apply:

Please submit your resume and a brief cover letter highlighting your experience with insurance benefits, eligibility verification, prior authorizations, billing, claim follow-up, and denial resolution.

Job Type:

Full-time Pay:

$25.00 - $35.00 per hour

Benefits:

Employee discount Health insurance Paid time off

Experience:

Medical Assisting:

1 year (Required)

Work Location:

In person