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Insurance Verification & Authorization Specialist

Company: U.S. Physical Therapy
Location: Bend
Posted on: June 6, 2021

Job Description:

Overview

Job Position: Insurance Verification & Authorization Specialist

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

Job Summary:

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 manner.

Job Responsibilities:

  • 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 treatment.
  • 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 Insurance denials.
  • 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 management.
  • Understanding of health care plan provisions/benefits, government and patient assistance programs.

Hours:

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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