Medical Insurance Verification/Authorization Specialist

Medical Insurance Verification and Authorization Specialist

Overview

Action Physical Therapy & Rehabilitation, Inc. is seeking a dependable and detail-oriented Medical Insurance Verification and Authorization Specialist to join our outpatient physical therapy team.

This position plays an important role in helping patients begin and continue therapy without unnecessary delays. The specialist will verify insurance benefits, obtain prior authorizations, monitor visit limits, respond to insurance documentation requests, and assist with selected accounts receivable aging follow-up.

The ideal candidate has experience working with health insurance companies, understands outpatient therapy benefits, and can communicate effectively with patients, therapists, physician offices, and insurance representatives.

Duties and Responsibilities

• Verify patient insurance eligibility and outpatient physical therapy benefits using insurance portals, electronic health record systems, and direct communication with insurance companies.
• Confirm deductibles, copayments, coinsurance, visit limits, referral requirements, authorization requirements, and other plan-specific restrictions.
• Obtain and track prior authorizations for physical therapy evaluations and treatment visits.
• Monitor authorization expiration dates, approved visit counts, and remaining visits to prevent interruptions in patient care.
• Request additional visits or authorization extensions when medically necessary.
• Review physical therapy evaluations, progress notes, plans of care, physician referrals, CPT codes, diagnosis codes, and other clinical information needed to support authorization requests.
• Communicate documentation requirements and authorization updates to therapists, front-office staff, billing personnel, and clinic supervisors.
• Respond to insurance company requests for medical records, evaluations, progress reports, plans of care, physician certifications, and other supporting documentation.
• Follow up with therapists and clinic staff when documentation is incomplete or additional information is needed.
• Submit requested documentation through insurance portals, fax, mail, or other approved methods while maintaining accurate records of all submissions.
• Follow up on pending, delayed, or denied authorization requests and assist with reconsiderations or appeals when appropriate.
• Communicate insurance coverage information and patient financial responsibilities clearly and professionally to patients.
• Assist with reviewing accounts receivable aging reports and following up on selected unpaid, delayed, or denied insurance claims.
• Contact insurance companies to determine claim status, identify missing information, and help resolve authorization-related or documentation-related payment issues.
• Document insurance verification, authorization activity, claim follow-up, and correspondence accurately in the appropriate system.
• Maintain patient confidentiality and comply with HIPAA requirements and company policies.
• Stay informed of changes involving insurance requirements, managed care policies, Medicare rules, therapy visit limits, and authorization procedures.
• Perform other administrative, billing, or insurance-related duties as assigned.

Requirements

• Previous experience in a medical office, outpatient therapy clinic, billing department, or healthcare administrative position is preferred.
• Experience with insurance verification, prior authorization, medical billing, accounts receivable, or claim follow-up is strongly preferred.
• Familiarity with outpatient physical therapy benefits, therapy visit limits, referrals, plans of care, and authorization requirements is preferred.
• Basic understanding of CPT codes, ICD-10 diagnosis codes, medical terminology, and healthcare documentation.
• Experience working with electronic health record systems, payer websites, and insurance portals.
• Proficiency with Microsoft Word, Excel, email, and general office technology.
• Strong organizational skills and attention to detail.
• Ability to manage multiple authorizations, documentation requests, and follow-up tasks at the same time.
• Excellent written and verbal communication skills.
• Ability to communicate professionally with patients, therapists, physician offices, insurance companies, and coworkers.
• Understanding of HIPAA requirements and the importance of maintaining patient confidentiality.
• Ability to work independently while contributing to a collaborative, patient-focused team.

Preferred Qualifications

• Experience in an outpatient physical therapy or rehabilitation setting.
• Experience obtaining authorizations for physical therapy, occupational therapy, or other rehabilitation services.
• Experience reviewing accounts receivable aging reports and following up on unpaid or denied claims.
• Familiarity with Medicare, Medicaid, commercial insurance, workers’ compensation, and managed care plans.

Join Action Physical Therapy & Rehabilitation, Inc. and help ensure our patients receive timely access to the therapy services they need. This position is essential to supporting patient care, maintaining accurate insurance information, and improving the efficiency of our authorization and reimbursement processes.

Work Location: In person

Salary : $35,845 - $44,700