Proliance Orthopaedics and Sports Medicine
Authorization & Benefit Specialist
Proliance Orthopaedics and Sports Medicine, Issaquah, Washington, United States, 98027
Proliance Orthopedic Sports Medicine Clinic Issaquah, Issaquah, Washington, United States of AmericaJob Description
Posted Wednesday, August 21, 2024 at 10:00 AMDescriptionProliance Surgeons is one of the largest surgical practices in the country, with over 450 providers including over 200 board-certified physicians providing treatment at more than 100 care centers in Washington State.At Proliance, our patients come from all walks of life and so do we. We hire, develop and engage great people from a wide variety of backgrounds and encourage growth and development to make our organization a great place to work. We draw on the differences in who we are, what we’ve experienced, and how we think to create
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!Position SummaryThe 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.Key Duties and ResponsibilitiesCoordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage.Able to triage incoming calls and requests from provider groups/patients 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.Any and all other duties as assigned.Education/ExperienceHigh School diploma/GED or equivalent.Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred.Medicare experience strongly preferred.Insurance experience and knowledge in commercial, work comp, and government payers required.Knowledge, Skills and AbilitiesAttention 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 DemandsThe 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.Work may be performed in an office and clinical environment. Requires corrected vision and hearing to normal range. While performing the duties of this job, the associate is regularly required to talk or hear. The associate is required to sit for long periods of time, stand and walk, bend and stretch. Use of telephone and computer is required. Manual dexterity required for use of computer keyboard. Occasionally lifts and carries items weighing up to 40 pounds. May require working under stressful conditions or working irregular hours.
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Posted Wednesday, August 21, 2024 at 10:00 AMDescriptionProliance Surgeons is one of the largest surgical practices in the country, with over 450 providers including over 200 board-certified physicians providing treatment at more than 100 care centers in Washington State.At Proliance, our patients come from all walks of life and so do we. We hire, develop and engage great people from a wide variety of backgrounds and encourage growth and development to make our organization a great place to work. We draw on the differences in who we are, what we’ve experienced, and how we think to create
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!Position SummaryThe 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.Key Duties and ResponsibilitiesCoordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage.Able to triage incoming calls and requests from provider groups/patients 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.Any and all other duties as assigned.Education/ExperienceHigh School diploma/GED or equivalent.Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred.Medicare experience strongly preferred.Insurance experience and knowledge in commercial, work comp, and government payers required.Knowledge, Skills and AbilitiesAttention 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 DemandsThe 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.Work may be performed in an office and clinical environment. Requires corrected vision and hearing to normal range. While performing the duties of this job, the associate is regularly required to talk or hear. The associate is required to sit for long periods of time, stand and walk, bend and stretch. Use of telephone and computer is required. Manual dexterity required for use of computer keyboard. Occasionally lifts and carries items weighing up to 40 pounds. May require working under stressful conditions or working irregular hours.
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