Authorizations and Benefits Specialist

Proliance Surgeons•Tacoma, WA

21d•Onsite

About The Position

At Proliance Surgeons, Bellingham Surgery Center and Surgery Center at Valley our patients come from all walks of life — and so do we. We hire and support people from diverse backgrounds, fostering growth and development to make Proliance a great place to work. Our unique experiences and perspectives help us deliver Exceptional Outcomes, Personally Delivered. We are proud to offer a comprehensive and competitive benefit and pay package including health coverage, 401k with match and profit share, PTO and more! For further details regarding Benefits and Washington State Minimum Wage details please visit our careers page at www.proliancesurgeons.com/careers Compensation during the offer process will be determined based on factors such as compensation structure, experience, qualifications, and internal equity. Be Part of Who We Are! Position Summary 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. Location: Proliance Puget Sound Orthopaedics - Tacoma Schedule: Monday through Friday 8:00am-5:00pm Experience: Surgery, MRI and/or Injections authorizations

Requirements

High School diploma/GED or equivalent
Customer service experience
Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred
Insurance experience and knowledge in commercial, work comp, and government payers required
Attention to detail, excellent organizational and time management skills
Ability to work both independently and as a team member
Demonstrated ability to learn quickly and function well in a fast paced, high-pressure environment
Great interpersonal skills; demonstrating patience, composure and cooperation; working well with all patients, physicians, staff, and other business associates
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
Work Environment/Physical Demands The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable differently abled persons to perform the essential functions.

Nice To Haves

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