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Insurance Benefit Specialist

Location: San Diego, California  

Company: Reproductive Partners San Diego  

Job Title: Insurance Benefit Specialist 

Salary Range: $22 – $25 Per Hour 

  

About Us:  

Reproductive Partners Fertility Center – San Diego is a leading Southern California fertility clinic, internationally and nationally recognized for our success in IVF (In Vitro Fertilization), egg freezing, and other fertility treatments for our patients.  

Position Overview:  

The Insurance Benefit Verification Specialist plays a vital role in ensuring seamless patient access to fertility treatments by managing insurance-related processes. This position is responsible for verifying patient insurance coverage, obtaining necessary authorizations, and coordinating benefits for fertility services. The Insurance Specialist works closely with patients, patient financial counselors, clinical teams, and insurance companies to ensure accurate billing, timely claims submissions, and resolution of any coverage issues. Strong written and verbal communication, attention to detail, and knowledge of fertility-specific insurance regulations are essential for success in this role. 

Key Responsibilities:  

Insurance Verification: 
  • Verify patients’ insurance coverage by contacting insurance companies via phone, online portals, or other appropriate channels. 
  • Obtain and document insurance eligibility, coverage details, copayments, deductibles, and any pre-authorization requirements. 
  • Update patient records with accurate insurance information and coverage details. 

Communication: 
  • Communicate effectively with patients regarding their insurance coverage and financial responsibilities. 
  • Educate patients on their insurance benefits, including copayments, deductibles, and out-of-pocket expenses. 
  • Address patients’ inquiries and concerns regarding insurance coverage and billing. 

Coordination: 
  • Collaborate with the patient financial counselors and the medical billing staff to ensure accurate billing based on verified insurance benefits and authorizations. 
  • Work closely with healthcare providers and administrative staff to facilitate a smooth patient experience. 

Documentation: 
  • Maintain detailed records of insurance verification activities, including communication with insurance companies and patients. 
  • Ensure all documentation adheres to HIPAA regulations and internal policies regarding patient confidentiality. 

Problem Resolution: 
  • Identify and resolve insurance-related issues, such as discrepancies in coverage or authorization denials. 
  • Escalate complex insurance cases to appropriate personnel for further resolution.  

Qualifications:  

High school diploma or equivalent work experience (bachelor’s degree preferred).  

Previous work experience in insurance benefit verification.  

Proficient in using electronic health records (EHR) and medical billing software.  

Proficient in Windows and Microsoft applications including Outlook, Word, and Excel.  

Working knowledge of Insurance and patient benefits. 

Strong interpersonal and communication skills.  

Exceptional customer service and multitasking abilities.  

Highly detail oriented and accurate in data entry.  

Knowledge of medical terminology is an advantage.  

Ability to work in a fast-paced, patient-focused environment.  

Benefits:  

Competitive salary.  

Health, dental, and vision insurance options.  

Retirement savings plan.  

Paid time off and holidays.  

Opportunities for professional development and growth.  

A friendly and supportive work environment.  

  

To perform the job successfully, an individual should demonstrate the following competencies:  

  

Customer Service – Displays courtesy and sensitivity; Manage difficult or emotional patient situations; Respond promptly to patient needs; Meet commitments.  

  

Dependability – Commit to doing the best job possible; Follow instructions, respond to management direction; Keeps commitments; Meets attendance and punctuality guidelines; Responds to requests for service and assistance; Take responsibility for own actions.  

  

Job Knowledge – Competency in required job skills and knowledge; Displays understanding of how job relates to others; Exhibit ability to learn and apply new skills; Require minimal supervision; Uses resources effectively.  

  

Teamwork – Balance team and individual responsibilities; Exhibit objectivity and openness to others’ views; Give and welcome feedback; Contribute to building a positive team spirit; Put success of team above own interests; Gives and welcomes feedback.  

  

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Employees will follow any other instructions, and perform any other related duties,   
as assigned by their manager.  

  

RPSD is an equal opportunity employer and welcomes applicants from all backgrounds to apply. Join our dedicated team and contribute to providing exceptional fertility care. Apply today!