Medical Prior Authorization & Billing 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

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.