Authorizations and Benefits Specialist Lead

Proliance Surgeons•Tacoma, WA

1d•Onsite

About The Position

The Authorization & Benefits Specialist Lead works alongside the Authorization and Benefits team while providing day-to-day guidance, support, and education within the scope of the role. This position helps ensure consistent processes, accurate and timely prior authorizations, and effective insurance verification. The Lead collaborates with leadership to support workflow improvements, maintain payer compliance, and promote a positive and efficient experience for both patients and team members.

Requirements

High school diploma or equivalent required.
Minimum 3 years of experience in a healthcare setting with responsibilities in prior authorization, insurance verification, and/or billing support.
Strong knowledge of Medicare, commercial insurance, workers’ compensation, and government payers required.
Proficient knowledge of medical terminology preferred at time of hire
Superior customer service skills
Strong leadership, training and mentoring abilities
Promoting (leading by example) great interpersonal skills; modeling patience, composure and cooperation; working well with all patients, physicians and team.
Ability to provide feedback to improve performance
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

Nice To Haves

Associate’s or Bachelor’s degree preferred or equivalent experience in a healthcare revenue cycle support role.
Familiarity with ICD-10, CPT and HCPCS codes preferred.
Experience mentoring or training team members preferred.

Responsibilities

Perform and support the full scope of prior authorization and insurance verification responsibilities as outlined for the Authorization & Benefits Specialist role.
Submit timely and accurate prior authorizations for procedures and surgeries according to payer guidelines.
Verify and document insurance coverage and network participation following current procedures and standards.
Review Explanation of Benefits (EOBs), address denials, and document actions for reprocessing or follow-up.
Handle inbound and outbound calls with patients, insurance companies, and clinical staff to support resolution of unpaid, denied, or rejected claims.
Assist in maintaining accuracy of payment posting and credit balance review processes in line with established protocols.
Use appropriate forms and documentation when initiating account changes such as adjustments or transfers.
Provide training and onboarding support for new Authorization & Benefits Specialists.
Address and resolve escalated issues related to authorizations, insurance denials, claims rejections, or complex patient inquiries.
Offer ongoing education, mentorship, and process guidance to team members based on current business practices and payer requirements.
Promote consistency by sharing updates and clarifications related to insurance changes, system updates, or department protocols.
Support department coverage and work alongside the team to maintain workload balance and meet daily operational needs.
Work closely with other departments (e.g., billing, medical records, and patient services) to ensure smooth coordination and timely resolution of issues related to patient authorization and insurance benefits.
Collaborate with Care Center leadership to monitor departmental workflows and ensure timely processing across all authorization functions.
Contribute to development and upkeep of training materials and workflow documentation.
Provide input on opportunities to improve efficiency, reduce errors, or enhance team support.
Participate in team meetings, provide feedback to leadership, and help foster a collaborative, patient-centered work environment.
Assist leadership with department-level initiatives and reporting when requested.