At MeBe, the Insurance Authorization Specialist plays a pivotal role in our mission to deliver exceptional pediatric behavioral health services. This position is crucial for streamlining insurance processes, ensuring timely approvals, and maximizing reimbursements, directly impacting patient access to care and the company's financial health. By handling complex authorization workflows, you contribute to operational efficiency in our growing organization based in San Diego. In your daily role, you will verify patient insurance eligibility and benefits by contacting payers and reviewing policy details at the start of each day. You will prepare and submit prior authorization requests for therapies and services, tracking submissions through payer portals and following up on statuses multiple times weekly. Collaborating with clinical teams, you will gather necessary documentation like treatment plans and medical records to support appeals for denied claims. Weekly, you will review outstanding authorizations, resolve discrepancies, and update patient records in our electronic health record system. Monthly, you will generate reports on authorization success rates, denial trends, and reimbursement metrics to inform leadership. You will also assist in payer contract negotiations by providing data insights and mentor junior staff on best practices for compliance with HIPAA and coding standards. Expect to handle high-volume inquiries from families and providers, ensuring all interactions are documented accurately. Candidates must have a high school diploma or equivalent, with an Associate's degree in healthcare administration or a related field preferred. At least 2-3 years of experience in medical insurance authorization, billing, or revenue cycle management is required, ideally in behavioral health or pediatrics. Proficiency in insurance software such as Availity, Change Healthcare, and EHR systems like Epic or Cerner is essential. Knowledge of CPT, ICD-10 coding, and HCPCS modifiers is mandatory, along with familiarity with major payers like Aetna, UnitedHealthcare, and Medi-Cal. Certification as a Certified Professional Coder (CPC) or in medical billing is highly desired. Strong understanding of prior authorization guidelines and appeal processes is non-negotiable. Technical expertise includes mastery of Microsoft Office Suite for reporting, with advanced Excel skills for data analysis. You should excel in verbal and written communication to negotiate with insurers and explain processes to non-clinical staff. Attention to detail, problem-solving under pressure, and organizational skills are key to managing deadlines. The ability to multitask in a fast-paced environment, maintain confidentiality, and demonstrate empathy in patient interactions sets top performers apart. Industry knowledge of behavioral health reimbursement challenges enhances effectiveness. MeBe is a leading provider of pediatric behavioral and developmental services, committed to empowering children through innovative therapies and family support. Our San Diego headquarters fosters a collaborative, child-centered culture with multidisciplinary teams including therapists, physicians, and administrators. We value work-life balance, continuous learning, and a supportive environment that celebrates diversity and inclusion, making us a unique place to grow in healthcare. We offer competitive compensation commensurate with experience, as salary details are not specified in the posting. Comprehensive benefits include medical, dental, and vision insurance, 401(k) with company match, and generous paid time off starting at 15 days annually. Additional perks feature flexible hybrid scheduling, professional development stipends, employee assistance programs, and wellness initiatives. Opportunities for performance-based bonuses and tuition reimbursement support long-term financial wellness. Advance your career with clear paths to senior specialist or revenue cycle manager roles through mentorship and training programs. Engage in ongoing education via workshops and certifications. To apply, visit our careers page and submit your resume today.