Job Description

The Insurance Verification & Authorization Specialist plays a vital role in ensuring that patient services are accurately authorized and covered by insurance plans. This position is responsible for managing insurance verifications, obtaining authorizations, and facilitating timely communication between clinics, providers, and insurers. The role requires high attention to detail, excellent communication skills, and the ability to manage multiple administrative processes in a fast-paced environment.

This is a full-time on-site position 40 hours per week, Monday through Friday. Start and end times may vary based on clinic and administrative needs.

Insurance Verification & Authorization

• Verify and validate insurance coverage for new and existing patients, ensuring benefit plans support proposed treatment.
• Obtain prior authorizations from insurance providers and referring physician offices in accordance with treatment protocols.
• Ensure all CPT and diagnosis codes are appropriate and accurately reflect the authorized services.
• Re-verify insurance details when necessary, including reviewing expiration dates and benefits changes.
• Confirm clinic location, treatment codes, and diagnoses align with the authorization obtained.

Documentation & Communication

• Maintain accurate and timely documentation in the insurance and EMR software systems.
• Resolve basic insurance issues and escalate complex cases to the Senior Insurance Specialist or Manager.
• Communicate authorization and insurance status clearly and efficiently with clinical and administrative teams.
• Coordinate with Front Office and clinicians for any in-visit changes to services, securing real-time authorization when possible.

Regulatory Compliance & Follow-up

• Review Medicare patients for coverage status and determine the need for applicable waivers.
• Monitor Medicaid patients for expired authorizations and ensure proper consent forms are completed if care continues without coverage.
• Stay current with Medicare, Medicaid, HIPAA regulations, and commercial insurance policy changes.

Administrative Support

• Track and update delayed charges logs.
• Notify Front Office of insurance denials so that patients can be promptly informed.
• Support the collection of accurate patient insurance data in collaboration with clinic staff.
• Perform additional duties as assigned by the supervisor.

Qualifications

Education & Experience

• Minimum 3 years of experience in medical billing, insurance verification, or authorizations.
• Experience with EMR systems and medical billing software strongly preferred.
• Working knowledge of insurance plans, including commercial, Medicare, Medicaid, and government assistance programs.

Skills & Competencies

• Proficient with Microsoft Office Suite (Excel, Word, Outlook).
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving skills.
• High attention to detail and accuracy in data handling.
• Ability to work independently and collaboratively in a dynamic team environment.

Personal Attributes

• Upholds a high level of confidentiality and professionalism.
• Organized with strong follow-through and time management.
• Friendly, flexible, and adaptable in a team-oriented setting.
• Able to prioritize tasks and manage multiple projects simultaneously.

Physical Requirements & Work Conditions

• This role is based in a professional office environment supporting multiple physical therapy clinics.
• Requires prolonged sitting, computer use, and occasional lifting or standing.
• Must have the ability to read detailed insurance documentation and clearly communicate by phone and in person.

Additional Information

The anticipated base salary range for this position is $21.00- $24.00. Salary is based on various factors, including relevant experience, knowledge, skills, other job-related qualifications, and geography. Medical, dental, vision, 401(k), paid time off, and other benefits are also available, subject to the terms of the Company's plan.