Authorization/Benefits Specialist

Proliance Surgeons; Renton, Northern (WA, KY); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Proliance Surgeons is seeking an Authorization and Benefits Specialist to efficiently manage accounts receivable while focusing on obtaining prior authorizations for procedures. The role supports patient communication, insurance verification, and timely billing to third party payers.

Ideal candidates will have at least 2 years of prior authorization and benefits experience, strong customer service skills, and Medicare experience.

Qualifications

• Must have at least 2 yrs of prior authorization and benefits experience, ideally in a clinic setting.
• Customer service experience.
• Experience in healthcare facility billing/receivable practices preferred.
• Medicare experience strongly preferred.
• Insurance experience and knowledge in commercial, work comp, and government payers required.

Responsibilities

• Coordinate and process medical prior authorizations for procedures by reviewing insurance and submitting needed information.
• Triage incoming calls and requests from providers/patients for authorization of services.
• Communicate professionally with patients, clinic staff, and outside vendors via phone, email, or written documentation and respond to inquiries.
• Verify and document insurance information per current practices and post payments received from patients/insurers.
• Review explanations of benefits, research denials, and process adjustments or transfers as needed.
• Assist with scheduling for surgeries as trained and other duties as assigned.

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.

Schedule

Monday - Friday, 8:30am - 4:30pm.

Key Duties and Responsibilities

The key duties and responsibilities of the Authorization and Benefits Specialist include, but are not limited to:

• 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 form 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
• Assisting with surgery scheduling (will train)
• Other duties as assigned

Education/Experience

• High School diploma/GED or equivalent
• Must have at least 2 yrs of previous authorization and benefits experience, ideally in a clinic setting.
• Customer service experience
• Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred
• 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.