Auth/Ben Specialist

Proliance Surgeons•Issaquah, WA

4d•Remote

About The Position

The Authorization and Benefits Specialist efficiently works accounts receivable while maintaining customer service, with a focus on obtaining prior authorization for procedures. This is a fully remote position, available to people currently located in or willing to relocate to Washington State, Arizona, Florida, Idaho, North Carolina, Ohio, Oregon, Rhode Island, Texas, and/or Tennessee. The employee must be able to work PST hours.

Requirements

High school diploma, GED, or equivalent.
Customer service experience.
At least 2 years of previous experience in a healthcare facility related to accounts receivable or billing practices.
Insurance experience and knowledge of commercial, workers’ compensation, and government payers.
Ability to work PST hours.
Must be located in or willing to relocate to Washington State, Arizona, Florida, Idaho, North Carolina, Ohio, Oregon, Rhode Island, Texas, and/or Tennessee.
Attention to detail and excellent organizational and time-management skills.
Ability to work independently and as a team member.
Ability to learn quickly and function in a fast-paced, high-pressure environment.
Strong interpersonal skills, including patience, composure, and cooperation when working with patients, physicians, staff, and business associates.
Understanding of and adherence to safety, risk-management, and precautionary procedures (OSHA/WISHA), including confidentiality requirements (HIPAA).
Self-motivation and ability to follow specific guidelines and detailed instructions, meet standards of excellence, and overcome challenges with little supervision.

Nice To Haves

Medicare experience is strongly preferred.

Responsibilities

Coordinate and process medical prior authorizations for surgical procedures by reviewing insurance and submitting information needed for coverage.
Triage incoming calls and requests from provider groups and patients concerning service authorization, questions, and status updates.
Communicate professionally with patients, clinic personnel, and outside vendors by phone, email, or other written documentation, and respond to inquiries.
Maintain working knowledge of health care plan requirements and health plan networks.
Verify and document insurance information according to current business practices.
Accurately post payments received from patients, attorney offices, and insurance companies.
Review explanations of benefits (EOBs) and research denials, rejections, and excessive reductions.
Use appropriate forms when requesting adjustments, insurance transfers, or other account changes.
Prepare and submit physician billing claims to third-party insurance carriers, electronically or by hard copy, and ensure timely and accurate submission.
Make outbound follow-up calls to patients or insurance companies about unpaid, denied, or rejected claims and document according to current policy.
Take inbound follow-up calls from patients or insurance companies about unpaid, denied, or rejected claims and document according to current policy.
Review credit balances and determine whether a patient or insurance company refund is applicable.
Perform other duties as assigned.