Summary
The Insurance Specialist at Balanced Physical Therapy + Wellness will be
responsible for ensuring that patients' insurance information is accurately
processed and verified before services are rendered, as well as managing the billing processes to ensure accurate and timely claims. This role plays a critical part in maintaining clinic operations & financial health by confirming insurance coverage and eligibility, understanding the benefits for physical therapy services, and providing a seamless experience for patients regarding their financial responsibilities.
This position works closely with patients, physical therapists, clinic teams,
insurance carriers, and the billing team to help ensure services are properly
authorized, claims are processed accurately, and insurance-related barriers to patient care are resolved efficiently.
The ideal candidate is highly organized, detail-oriented, knowledgeable about health insurance processes, and comfortable working in a fast-paced healthcare environment.
About the Role
Insurance Verification:
Verify patient insurance eligibility and benefits prior to or at the beginning of care.
Review benefits for physical therapy and related rehabilitation services, including Deductibles_Copayments_Coinsurance_Out-of-pocket maximums_Visit limitations_Therapy-specific benefits_In-network and out-of-network benefits
Accurately document insurance information and benefit details in the patient management system.
Identify potential insurance issues that may impact the patient's plan of care or financial responsibility.
Communicate benefit information clearly and professionally to clinic staff and patients.
Pre-Authorization and Referrals:
Obtain and manage insurance authorizations for physical therapy services when required.
Track authorization approval dates, visit limits, expiration dates, and remaining visits.
Monitor authorization usage and communicate upcoming expiration or visit limits to appropriate clinic staff.
Submit additional authorization requests when medically necessary.
Follow up with insurance companies regarding pending authorization requests.
Identify referral or prescription requirements and coordinate with appropriate providers when necessary.
Maintain accurate records of authorization activity.
Patient Communication:
Assist patients with questions regarding insurance coverage, benefits, authorizations, and financial responsibility.
Explain insurance information in a clear, professional, and patient-friendly manner.
Help patients understand that insurance benefits are estimates and that the patient's insurance plan ultimately determines coverage.
Maintain confidentiality and professionalism when handling protected health information.
Accurately enter and update patient insurance information into the clinic’s electronic health record and billing systems. Maintain detailed records of all verification activities and communications.
Resolve insurance-related issues or discrepancies, including denied claims or re-submissions, to ensure timely and accurate reimbursement.
Coordination with Clinical Staff:
Serve as an insurance resource for physical therapists, therapy technicians, front-office staff, and clinic leadership.
Communicate insurance and authorization updates to clinics in a timely manner.
Help identify potential barriers to continued patient care.
Collaborate with the billing and front-office teams to resolve insurance discrepancies.
Assist with payer-specific requirements and changes.
Provide feedback to leadership regarding recurring insurance, authorization, or reimbursement issues.
Compliance & Confidentiality:
Maintain strict confidentiality of patient and financial information.
Follow HIPAA requirements and organizational privacy and security policies.
Follow payer requirements, company policies, and applicable healthcare regulations.
Maintain accurate and complete documentation.
Handle protected health information responsibly and only access information necessary to perform job responsibilities.
Requirements
Qualifications:
● Education: High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, business, or a related field preferred.
● Experience: Minimum of 1-2 years of experience in medical insurance verification, billing, or a related role, preferably within a Physical Therapy or Healthcare setting.
Skills:
● Strong knowledge of insurance terminology, medical billing codes, and healthcare reimbursement processes.
● Excellent communication skills, both written and verbal, with a professional and patient-friendly demeanor.
● Proficient in using EMR systems, insurance verification software, and Microsoft Office Suite (Word, Excel, Outlook).
● Detail-oriented with strong organizational and time management skills.
● Ability to multitask and handle a high volume of verifications in a fast-paced environment.
● Strong problem-solving skills and the ability to work independently or as part of a team.
● Experience in a physical therapy clinic or similar healthcare environment. Certification in medical billing and coding or insurance verification is a plus.
Personal Attributes:
● Problem-solving mindset with the ability to resolve billing and insurance issues effectively.
● Professional and patient-friendly demeanor.
● High level of integrity and commitment to maintaining patient confidentiality.
About the Company
Balanced Physical Therapy + Wellness is committed to providing an exceptional multidisciplinary patient care experience that promotes healing & recovery in a compassionate environment to meet the needs of each individual patient. We are guided by achieving compassion, integrity, service, teamwork, and a commitment to excellence. Balanced Physical Therapy was established in 2015 with the mission of creating a fun, vibrant family practice environment emphasizing compassionate patient care by knowledgeable, energetic therapists. This philosophy, along with an excellent team of very skilled and accomplished therapists, has helped Balanced Physical Therapy + Wellness grow from a small, two therapist clinic into a thriving multi-specialty practice with 10 clinics and 100+ employees in just 10 years. Join a fun and vibrant family practice environment, emphasizing compassionate patient care!
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