Auth/Ben Specialist

Proliance Surgeons•Issaquah, WA

4d•$20 - $32•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, but the employee must currently reside in or be willing to relocate to Washington, Arizona, Florida, Idaho, North Carolina, Ohio, Oregon, Rhode Island, Texas, or Tennessee, and must be able to work Pacific Time hours. The role coordinates medical prior authorizations and handles billing and accounts-receivable activities, including insurance verification, claim submission, payment posting, denial research, and follow-up with patients and insurers. The specialist communicates with patients, clinic personnel, provider groups, and outside vendors, and follows applicable business practices and confidentiality requirements.

Requirements

High school diploma, GED, or equivalent.
Customer service experience.
Two 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.
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, including OSHA/WISHA and HIPAA confidentiality requirements.
Self-motivation and ability to follow guidelines and detailed instructions, meet standards of excellence, and overcome challenges with little supervision.
Must be located in or willing to relocate to Washington, Arizona, Florida, Idaho, North Carolina, Ohio, Oregon, Rhode Island, Texas, or Tennessee.
Must be able to work Pacific Time hours.

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 authorization of services, 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 healthcare 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 and research denials, rejections, and excessive reductions.
Use appropriate forms when requesting adjustments, insurance transfers, or other specific account changes.
Prepare and submit physician billing claims to third-party insurance carriers, electronically or in hard copy, and ensure timely claim accuracy.
Make outbound follow-up calls to patients or insurance companies regarding unpaid, denied, or rejected claims, and document according to current policy.
Take inbound follow-up calls from patients or insurance companies regarding unpaid, denied, or rejected claims, and document according to current policy.
Review and work credit balances to determine whether a patient or insurance refund is applicable.
Perform other duties as assigned.