Summary
The Insurance Verification & Authorization 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.
About the Role
Insurance Verification: Verify insurance coverage and benefits for physical therapy services by contacting insurance companies via phone, email, or online portals. Confirm co-pays, deductibles, co-insurance, and any pre-authorization requirements.
Pre-Authorization and Referrals: Obtain necessary pre-authorizations, referrals, or documentation from insurance companies or referring providers to ensure timely service delivery. Maintains spreadsheets to track authorizations and communicates with therapists regarding plan of care. Apply for authorizations in a timely manner to decrease lapse of therapy services.
Billing and Claims Management: Prepare and submit clean claims to insurance companies for payment using clinic billing software. Ensure that all claims are submitted in a timely manner and in accordance with insurance guidelines.
Patient Billing and Statements: Generate and distribute patient statements for balances due after insurance payments. Provide patients with clear explanations of their financial responsibilities, including outstanding balances, co-pays, and deductibles.
Patient Communication: Communicate with patients regarding their insurance coverage, benefits, and any out-of-pocket expenses prior to their appointments. Provide clear explanations of coverage limitations, deductibles, co-payments, and co-insurance.
Data Entry and Documentation: 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.
Claims Management Support: Resolve insurance-related issues or discrepancies, including denied claims or re-submissions, to ensure timely and accurate reimbursement.
Coordination with Clinical Staff: Work closely with physical therapists and administrative staff to coordinate patient care based on insurance benefits and authorization requirements.
Compliance: Stay current with industry regulations, including HIPAA and other relevant federal, state, and local guidelines. Ensure all insurance verification activities comply with clinic policies and procedures.
FAX Management: Process all faxes upon arrival - Referrals, Medical Records Requests, Billing Inquiries, Signed POC’s-Notes.
Requirements
Education: High school diploma or equivalent required; associate’s 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 (WebPT – Prompt), 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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