Kaiser Insurance Specialist/Manager - Fertility Center

About Us:

Reproductive Fertility Center is a leading and compassionate fertility clinic dedicated to helping individuals and families build their dreams. We pride ourselves on exceptional patient care and a supportive team environment. To enhance our specialized services, we are seeking an expert solely focused on managing our relationship and billing with Kaiser Permanente.

The Opportunity:

This is not a general billing role. We are looking for a dedicated subject matter expert to own and manage all aspects of our interactions with Kaiser Permanente insurance. You will be the central point of contact and the key to ensuring seamless financial operations for our Kaiser patients.

Key Responsibilities:

Act as the in-house authority on all Kaiser Permanente policies, procedures, and network requirements. Verify patient eligibility and obtain all necessary pre-authorizations and referrals from Kaiser. Accurately prepare, submit, and track claims exclusively for Kaiser insurance. Proactively manage and resolve claim denials, delays, and underpayments through effective appeals and follow-up. Serve as the main liaison between our clinic and Kaiser representatives, building strong professional relationships. Educate and counsel patients on their specific Kaiser coverage, benefits, and financial responsibilities. Collaborate with clinical staff to ensure documentation meets Kaiser's specific criteria for medical necessity. Analyze and optimize the Kaiser-specific revenue cycle workflow.

Must-Have Qualifications:

Minimum 7 years of direct and recent experience working within Kaiser Permanente. (Experience in billing, claims, authorizations, or member services is essential). Deep, practical knowledge of Kaiser's internal systems (e.g. KP HealthConnect), closed network model, referral pathways, and billing protocols. Proven expertise in medical billing, CPT/ICD-10 coding, and the full claims cycle. Strong problem-solving skills and tenacity in resolving complex insurance issues. Excellent communication and patient-facing skills.

Ideal Candidate Will Have:

Experience in fertility, women's health, obstetrics/gynecology, or another specialty healthcare setting. Familiarity with Kaiser plans specific to California. Certification in medical billing and coding CPC is a plus.

Pay:

From $70,000.00 per year

Benefits:

401(k) Dental insurance Employee discount Flexible schedule Free parking Health insurance Life insurance Paid time off Professional development assistance Retirement plan Travel reimbursement Vision insurance

Work Location:

In person