Authorization/Benefits Specialist

Proliance Surgeons•Renton, WA

16d•Onsite

About The Position

The Authorization and Benefits Specialist is responsible for efficiently working accounts receivable while maintaining customer service. The role focuses on obtaining prior authorization for procedures and requires full-time, on-site work at the Renton clinic in Renton, Washington. The schedule is Monday through Friday, 8:30 a.m. to 4:30 p.m.

Requirements

High school diploma, GED, or equivalent.
At least two years of previous authorization and benefits experience.
Customer service experience.
Required insurance experience and knowledge involving 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 (OSHA/WISHA), including consistent respect for confidentiality (HIPAA).
Self-motivation and ability to work with little supervision, follow specific guidelines and detailed instructions, measure work against standards of excellence, and overcome obstacles and challenges.

Nice To Haves

Previous experience in a healthcare facility relating to accounts receivable or billing practices.
Medicare experience.
Authorization and benefits experience in a clinic setting.

Responsibilities

Coordinate and process medical prior authorizations for surgical procedures by reviewing insurance and submitting information required for coverage.
Triage incoming calls and requests from provider groups and patients regarding authorizations, questions, and status updates.
Communicate professionally with patients, clinic personnel, and outside vendors by phone, email, and 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 Explanation 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 claim accuracy.
Make outbound follow-up calls to patients or insurance companies concerning unpaid, denied, or rejected claims, documenting calls according to policy.
Take inbound follow-up calls from patients or insurance companies concerning unpaid, denied, or rejected claims, documenting calls according to policy.
Review and work credit balances to determine whether a patient or insurance company refund is applicable.
Assist with surgery scheduling after training.
Perform other duties as assigned.