Position Summary
The Authorization & Benefits Specialist Lead works alongside the Authorization and Benefits team while providing day-to-day guidance, support, and education within the scope of the role. This position helps ensure consistent processes, accurate and timely prior authorizations, and effective insurance verification. The Lead collaborates with leadership to support workflow improvements, maintain payer compliance, and promote a positive and efficient experience for both patients and team members.
Location: Proliance Puget Sound Orthopaedics - Tacoma
Schedule: Monday through Friday, 8:00am - 5:00pm
Key Duties and Responsibilities
The key duties and responsibilities of the Authorization & Benefits Specialist Lead include, but are not limited to:
Authorization & Benefits
- Perform and support the full scope of prior authorization and insurance verification responsibilities as outlined for the Authorization & Benefits Specialist role.
- Submit timely and accurate prior authorizations for procedures and surgeries according to payer guidelines.
- Verify and document insurance coverage and network participation following current procedures and standards.
- Review Explanation of Benefits (EOBs), address denials, and document actions for reprocessing or follow-up.
- Handle inbound and outbound calls with patients, insurance companies, and clinical staff to support resolution of unpaid, denied, or rejected claims.
- Assist in maintaining accuracy of payment posting and credit balance review processes in line with established protocols.
- Use appropriate forms and documentation when initiating account changes such as adjustments or transfers.
Lead Responsibilities
- Provide training and onboarding support for new Authorization & Benefits Specialists.
- Address and resolve escalated issues related to authorizations, insurance denials, claims rejections, or complex patient inquiries.
- Offer ongoing education, mentorship, and process guidance to team members based on current business practices and payer requirements.
- Promote consistency by sharing updates and clarifications related to insurance changes, system updates, or department protocols.
- Support department coverage and work alongside the team to maintain workload balance and meet daily operational needs.
- Work closely with other departments (e.g., billing, medical records, and patient services) to ensure smooth coordination and timely resolution of issues related to patient authorization and insurance benefits.
- Collaborate with Care Center leadership to monitor departmental workflows and ensure timely processing across all authorization functions.
- Contribute to development and upkeep of training materials and workflow documentation.
- Provide input on opportunities to improve efficiency, reduce errors, or enhance team support.
- Participate in team meetings, provide feedback to leadership, and help foster a collaborative, patient-centered work environment.
- Assist leadership with department-level initiatives and reporting when requested.
Education/Experience
- High school diploma or equivalent required.
- Associate’s or Bachelor’s degree preferred or equivalent experience in a healthcare revenue cycle support role.
- Minimum 3 years of experience in a healthcare setting with responsibilities in prior authorization, insurance verification, and/or billing support.
- Strong knowledge of Medicare, commercial insurance, workers’ compensation, and government payers required.
- Familiarity with ICD-10, CPT and HCPCS codes preferred.
- Experience mentoring or training team members preferred.
Knowledge, Skills and Abilities
- Proficient knowledge of medical terminology preferred at time of hire
- Superior customer service skills
- Strong leadership, training and mentoring abilities
- Promoting (leading by example) great interpersonal skills; modeling patience, composure and cooperation; working well with all patients, physicians and team.
- Ability to provide feedback to improve performance
- 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.
JobFamily
ADMINISTRATIVE
PayType
Hourly
EmploymentIndicator
Full Time
HiringMinRate
20.96
HiringMaxRate
33.54