Authorization & Benefits Specialist

Proliance Surgeons•Seattle, WA

8d•Hybrid

About The Position

At Proliance Surgeons - Orthopedic Specialists of Seattle, we believe great patient care starts with a supported and appreciated team. We foster a collaborative, respectful culture where employees are encouraged to grow, learn, and pursue new opportunities. In addition to meaningful work and pathways for professional development, we prioritize employee appreciation with perks like free coffee, weekly complimentary lunches, an annual holiday party, and other team-building events, because we believe a positive, connected workplace matters. Travel between Wallingford and Ballard offices required, based on business needs. The Authorization and Benefits Specialist is responsible for efficiently working accounts receivable for the organization, while maintaining customer service. This position will focus on obtaining prior authorization for procedures.

Requirements

High School diploma/GED or equivalent
Customer service experience
Insurance experience and knowledge in commercial, work comp, and government payers required
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

Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred
Medicare experience strongly preferred

Responsibilities

Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage
Able to triage incoming calls and requests form provider groups/patient for authorization of services, questions, status updates
Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
Maintain a working knowledge of health care plan requirements and health plan networks
Verify and document insurance information as defined by current business practices
Accurately post all payments received from patients, attorney offices and/or insurance companies
Review Explanation of Benefits (EOB), research denials, rejections and/or excessive reductions
Ensure appropriate forms are used when requesting adjustments, insurance transfers or other specific account changes
Prepare, submit and ensure timely claim accuracy for all physician billing to third party insurance carriers either electronically or via hard copy
Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
Take inbound calls from patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
Review and work any credit balances to determine if patient and/or insurance company refund is applicable
Other duties as assigned