Insurance Verification & Authorization Specialist
Company: U.S. Physical Therapy
Posted on: June 6, 2021
Job Position: Insurance Verification & Authorization
Location: Bend, OR
Years' Experience Required: 2+ years
Employment Type: Full Time
Benefits: Complete Benefits Package to include generous paid
time off and a 401k
Business: Outpatient Therapy Clinic
This position is responsible for expediting the administrative
requirements for patient referrals, dealing directly with health
plans or referring physicians' offices, ensuring proper
notification/authorization have been obtained in a timely
- Verifies and validates patient's insurance coverage and
determines if the benefit plan considers recommended treatment
appropriate based on patient needs.
- Re-verify existing patient insurance coverage and determine if
the benefit plan considers recommended treatment appropriate based
on patient needs.
- Completes all required paperwork necessary to obtain
authorization and verify that CPT & Diagnosis codes are specific to
- Obtain authorization and confirm clinic location and CPT &
Diagnosis codes matches the authorization.
- Maintain and update delayed charges logs.
- Enters information and notes regarding verification for patient
care into the insurance software in a clear and timely manner.
- Resolves any issues with coverage and escalates complicated
issues to Sr Ins Specialist and/or Manager.
- Communicates information effectively both verbally and in
writing to appropriate clinic and administrative personnel.
- Contact person for FO/Clinician for procedures that are changed
or added during a patient's appointment so that appropriate
authorization can be made while the patient is being seen.
- Reviews all scheduled patients for Medicare coverage and checks
reason code to determine if a Medicare waiver is needed.
- Reviews all scheduled patients for Medicaid coverage & verifies
if auth is expired. If expired & patient wishes to continue
treatment w/o auth in place, complete the OHP form & email to FO
for patient to sign before treatment begins.
- Helps to foster collaboration between all staff with the
gathering patient information.
- Maintain comprehensive knowledge of medical billing, insurance
plans, Medicare and HIPAA compliance.
- Contact Front Office so they can contact the patient with any
- Other duties as assigned.
Education & Experience Qualifications:
- Three-plus years in the field of medical insurance
verification, medical billing and medical billing software;
implementation and experience with EMR are an asset.
- Proficient computer skills including MS Office Suite (Excel,
Word and Outlook).
- Excellent customer service skills.
- Effective analytical skills; ability to present, communicate
initiatives, results and analyses to multiple levels of
- Understanding of health care plan provisions/benefits,
government and patient assistance programs.
The Insurance Verification & Authorization Specialist is a
full-time position. The schedule generally consists of 40-hours per
week, Monday - Friday. The starting and ending times may vary
depending on the needs of the office and staffing.
Keywords: U.S. Physical Therapy, Bend , Insurance Verification & Authorization Specialist, Other , Bend, Oregon
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