The Benefits Coordinator/Authorization Specialist serves as a vital link between insurance companies and clinical staff. This position is responsible for verifying patient insurance benefits, obtaining prior authorizations, and communicating information to the appropriate office personnel. The Benefits Coordinator/Authorization Specialist plays a key role in the revenue cycle by ensuring accurate benefit information is captured upfront to minimize claim denials and patient billing surprises.
Position Responsibilities: (including, but not limited to)
Insurance Verification & Eligibility
- Verify patient insurance eligibility and benefits for all scheduled appointments and procedures
- Confirm coverage details including deductibles, co-pays, coinsurance, and out-of-pocket maximums
- Identify in-network vs. out-of-network benefits across all service lines
- Document benefit information accurately in the practice management system
- Communicate benefit details to office scheduling staff.
- Communicate any Demographic errors with appropriate office staff.
Prior Authorization Management
- Obtain prior authorizations for medical and surgical procedures across all specialties
- Coordinate authorizations for specialty services including:
- Audiology Hearing Aide services
- ENT procedures (sinus surgery, tonsillectomy, septoplasty, etc.)
- Facial plastic and reconstructive surgery
- Full body plastic surgery (cosmetic vs. reconstructive determinations)
- Practice owned Ambulatory Surgery Center (ASC) facility.
- Physical Therapy for Fyzical Balance Centers
- Track authorization status and follow up on pending requests
- Maintain authorization logs and ensure timely renewals
- Work closely with Billing Specialists, Surgical Coordinators, and Clinical Managers
- Stay current on payer policies, coverage guidelines, and authorization requirements
General Responsibilities
- Participate in revenue cycle meetings and process improvement initiatives
- Identify and resolve billing complaints, answer questions from staff, patients and insurance companies.
- Ensure departmental adherence to Medicare compliance regulations
- Maintain the strictest confidentiality; adhere to all HIPAA guidelines/regulations.
- Successful completion of special projects as assigned.
- Participate in educational activities and attend staff meetings.
- Identify and resolve billing complaints, answer questions from staff, patients and insurance companies.
Education and/or Experience
- High school diploma or equivalent
- Minimum 2-3 years of experience in medical billing
- Strong knowledge of medical insurance plans (commercial, Medicare, Medicaid, Tricare)
- Familiarity with medical terminology and CPT/ICD-10 codes
- Experience with practice management systems and EHR platforms
- Excellent communication and customer service skills
- Knowledge of basic medical coding and third-party operation procedures and practices.
- Ability to operate a multi-line telephone system and answer a telephone in a pleasant and helpful manner.
- Familiarity with Microsoft applications, including, but not limited to Word and Excel.
- Strong written and verbal communication skills including the ability to confidently speak to patients
- Excellent organizational skills to manage multiple tasks throughout the day.
- Demonstrate the ability to work as a team player in a very cohesive medical practice.
- Ability to communicate and work well with co-workers. Open and honest communication.
- Ability to effectively communicate orally and in writing with internal and external business professionals.
- Must be responsible, reliable, and able to carry out job functions
Total Rewards
The referenced base salary range represents the low and high end of Specialty Care Networks’ salary range for this position. Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate’s geographical location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/ training and other qualifications. Specialty Care Network offers a total rewards package that supports our employee’s life, career and retirement.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
