Therapy Authorizations and Scheduling Specialist

Position: Therapy Authorizations and Scheduling Specialist

Reports to: Business Office SupervisorandDirector of Therapy Services

Position Summary: The Therapy Eligibility Authorizations and Scheduling Specialist is responsible for verifying client insurance benefits, handling denials, communicating with therapists about covered and uncovered services, scheduling therapy patients and assisting with other general office and department needs.

Specific Responsibilities:

A. Insurance Eligibility and Authorizations

1. Receives new orders from Therapy Aide to prepare for initial evaluation

2. Calls insurance provider or check Web Portal for eligibility and limitations

3. Checks start dates, visit limits and authorizations as needed

4. Verifies authorization for supplies/orthoses ordered by physician

5. Checks co-insurance and co-pays

6. Completes co-pay forms given to clients at initial evaluation

B. Follow-up for Continued Care

• Processes Authorizations
• Updates therapy chart in WebPT with authorization dates, visit limitations, co-pays and any other pertinent information
• Assists with visit tracking for therapist to complete necessary documentation for visit or authorization extension
• Requests any extra authorization for additional supplies ordered for care

C. Managing Therapy Billing

1. Processes all therapy billing

2. Receives the notice denial (Explanation of Benefits) from the billing office

3. Performs follow-up phones calls with insurance and clients

4. Performs follow-ups with therapist for additional information needed if necessary

5. Responsible for working Therapy Accounts Receivable

D. Therapy Scheduling

1. Schedules Post Op/ Surgical appointments

2. Schedules Outside Therapy Orders appointments

3. Schedules Non-Surgical Therapy appointments

E. Educational Requirements

• High school diploma
• Some work in healthcare is encouraged but not necessary
• Knowledge of Word system and competent computer skills
• Recommend experience working with healthcare billing, denials and authorizations

F. Other Job-Related Duties and Responsibilities

• Cross covers Therapy Aide for days off and vacations
• Scans and uploads all documents that require signature from physician
• After upload, update necessary plan of care dates in WebPT
• Assists with scheduling daily appointments and follow-up as dictated therapist
• Answers phone calls for the department as needed to assist Therapy Aide
• Assists with other department needs, supplies and laundry ect, as time allows
• Performs other related duties as assigned by director.

Qualifications

A. Possesses strong interpersonal skills to interact with patients and their families.

B. An ability to work with a team approach and coordinate multiple schedules.

Working Conditions

A. Environmental Conditions

Inside: 95-100% Outside: 0-5% Temperature: 30°F-115°F

Fumes: seldom Dust: occasional Gases: never

Odors: seldom Mist: seldom Radiation: never

Noise or Vibrations: Running equipment, testing equipment, alarm buzzers, phones, computer and printer, and possible office equipment, music.

Hazards: Contact with communicable disease, electrical equipment, bloodborne pathogens, etc.

Personal Protective Equipment: Provided gowns, gloves, goggles and masks.

B. Physical Demands

Standing: 0-15% Sitting: 10-100%

Walking: 0-20% Lifting: 35# infrequently, 20# or less frequently

Carrying: 0-25lbs infrequently Pushing: 0-400 lbs via wheelchair infrequently

Kneeling: rarely Pulling: infrequent

Bending: occasional Squatting: infrequent

Crawling: no

Reaching: in frequent

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Work Location: In person