Auth/Ben Specialist

Proliance Surgeons; Issaquah (WA); Remote; USD 45,000 - 65,000; Full time

Job summary

Proliance Surgeons is seeking an Authorization and Benefits Specialist to manage accounts receivable while ensuring excellent customer service. The role focuses on obtaining prior authorizations for procedures and coordinating with patients, clinics, and insurers.

Fully remote but requires current location or willingness to relocate to specified states and ability to work PST hours; two years healthcare AR/billing experience and Medicare familiarity are preferred.

Qualifications

• High School diploma/GED or equivalent.
• 2 years experience in a healthcare facility related to accounts receivable or billing.
• Medicare experience preferred.
• Insurance experience across commercial, workers' comp and government payers.

Responsibilities

• Coordinate and process medical prior authorizations for surgical procedures by reviewing insurance and submitting required information.
• Triage calls and requests from providers/patients for authorization of services and status updates.
• Maintain professional communication with patients, clinic staff, and outside vendors via phone or written documentation; respond to inquiries.
• Know healthcare plan requirements and networks; stay updated on changes.
• Verify and document insurance information per current business practices.
• Post all payments from patients, attorney offices, and/or insurers accurately.
• Review Explanation of Benefits (EOB), research denials and reductions.
• Use required forms for adjustments, insurance transfers, or account changes.
• Prepare and submit timely claims to third-party insurers electronically or on paper.
• Follow up with patients or insurers on unpaid/denied claims; document per policy.
• Address credit balances to determine refunds due to patient or insurer.
• Other duties as assigned.

Skills

Customer service

Attention to detail

Time management

Team player

Communication

HIPAA compliance

Education

High School diploma/GED

Job description

Position Summary

The Authorization and Benefits Specialist is responsible for efficiently working accounts receivable for the organization, while maintaining customer service. This position will focus on obtaining prior authorization for procedures.

*Fully Remote but must be currently located, or willing to relocate to the following states - Washington State, Arizona, Florida, Idaho, North Carolina, Ohio, Oregon, Rhode Island, Texas, and/or Tennessee. Must also be able to work PST hours.

*2 years previous experience in a healthcare facility in relation to accounts receivable or billing practices required

Key Duties and Responsibilities

• Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage
• Able to triage incoming calls and requests from provider groups/patient for authorization of services, questions, status updates
• Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
• Maintain a working knowledge of health care plan requirements and health plan networks
• Verify and document insurance information as defined by current business practices
• Accurately post all payments received from patients, attorney offices and/or insurance companies
• Review Explanation of Benefits (EOB), research denials, rejections and/or excessive reductions
• Ensure appropriate forms are used when requesting adjustments, insurance transfers or other specific account changes
• Prepare, submit and ensure timely claim accuracy for all physician billing to third party insurance carriers either electronically or via hard copy
• Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
• Take inbound calls from patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
• Review and work any credit balances to determine if patient and/or insurance company refund is applicable
• Other duties as assigned

Education/Experience

• High School diploma/GED or equivalent
• Customer service experience
• 2 years previous experience in a healthcare facility in relation to accounts receivable or billing practices required
• Medicare experience strongly preferred.
• Insurance experience and knowledge in commercial, work comp, and government payers required

Knowledge, Skills and Abilities

• Attention to detail, excellent organizational and time management skills
• Ability to work both independently and as a team member
• Demonstrated ability to learn quickly and function well in a fast paced, high-pressure environment
• Great interpersonal skills; demonstrating patience, composure and cooperation; working well with all patients, physicians, staff, and other business associates
• Understanding of and adherence to all safety, risk management and precautionary procedures (OSHA/WISHA), including the consistent respect for confidentiality (HIPAA)
• Self-motivated; able to work following specific guidelines and in accordance with detailed instructions; measure self against standard of excellence, overcome obstacles and challenges with little supervision

Work Environment/Physical Demands

The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable differently abled persons to perform the essential functions.