Authorization/Benefits Specialist

Proliance Surgeons•Renton, WA

17d•$20 - $32•Onsite

About The Position

The Authorization and Benefits Specialist works accounts receivable while maintaining customer service, with a focus on obtaining prior authorization for procedures. This is a full-time, on-site position at the Renton clinic location. The schedule is Monday through Friday, 8:30 a.m. to 4:30 p.m. The role may also assist with surgery scheduling, with training provided.

Requirements

High school diploma, GED, or equivalent.
At least 2 years of prior authorization and benefits experience; clinic-setting experience is ideal.
Customer service experience.
Insurance experience and knowledge of commercial, workers' compensation, and government payers.
Attention to detail, strong organizational skills, and time-management skills.
Ability to work independently and as a team member.
Ability to learn quickly and function well 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 requirements and HIPAA confidentiality.
Self-motivation and ability to follow guidelines and detailed instructions, meet standards of excellence, and overcome challenges with little supervision.

Nice To Haves

Previous experience in a healthcare facility involving accounts receivable or billing practices.
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 about authorizations, 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, research denials and rejections, and investigate 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 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 company refund is applicable.
Assist with surgery scheduling after training.
Perform other duties as assigned.