Benefits and Authorization Specialist – Specialty Care

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Verify patient insurance eligibility and benefits for scheduled appointments and procedures

• Confirm deductibles, co-pays, coinsurance, and out-of-pocket maximums

• Identify in-network and out-of-network benefits across service lines

• Accurately document benefit information in the practice management system

• Communicate benefit details to office scheduling staff

• Report demographic discrepancies to the relevant office personnel

• Obtain prior authorizations for medical and surgical procedures across various specialties

• Coordinate authorizations for audiology hearing aid services, ENT procedures, facial plastic and reconstructive surgery, full body plastic surgery, ambulatory surgery center services, and physical therapy

• Track the status of authorizations and follow up on pending requests

• Maintain authorization logs and ensure timely renewals

• Collaborate with Billing Specialists, Surgical Coordinators, and Clinical Managers

• Stay updated on payer policies, coverage guidelines, and authorization requirements

• Participate in revenue cycle meetings and process improvement initiatives

• Identify and resolve billing complaints while addressing inquiries from staff, patients, and insurance companies

• Uphold confidentiality and comply with HIPAA guidelines/regulations

• Complete special projects as assigned

• Attend staff meetings and participate in educational activities

⛳️ Requirements

• High school diploma or equivalent

• Minimum of 2–3 years of experience in medical billing

• Strong understanding of medical insurance plans, including commercial, Medicare, Medicaid, and Tricare

• Familiarity with medical terminology and CPT/ICD-10 codes

• Experience with practice management systems and EHR platforms

• Excellent communication and customer service abilities

• Knowledge of basic medical coding and third-party operational procedures and practices

• Ability to operate a multi-line telephone system

• Proficient in Microsoft applications, including Word and Excel

• Strong written and verbal communication skills

• Exceptional organizational skills and capability to manage multiple tasks

• Ability to work collaboratively within a cohesive medical practice

• Capability to communicate effectively with co-workers

• Ability to engage orally and in writing with both internal and external business professionals

• Must demonstrate responsibility, reliability, and the capacity to fulfill job functions

• Commitment to confidentiality and adherence to HIPAA guidelines/regulations

• Ability to ensure departmental compliance with Medicare regulations

🏝️ Benefits

• Comprehensive rewards package supporting employees’ personal, professional, and retirement goals

• Opportunities for educational activities and participation in staff meetings

• Professional development through engagement in educational initiatives