Billing & Insurance Authorization Specialist

Tender Touch Therapy, LLC.; Mount Pleasant (WI); On-site; USD 42,000 - 64,000; Full time

Job summary

Tender Touch Therapy, LLC. in Mount Pleasant, WI seeks an experienced Billing & Insurance Authorization Specialist for a busy pediatric therapy practice. You will manage the revenue cycle and perform insurance verifications, eligibility checks, and prior authorizations, with EMR/Practice Management software as a core tool.

The role is temporary, with flexible full- or part-time hours, Monday–Friday. You will collaborate with therapists and the rehab director to optimize funding, streamline

Qualifications

• Experience with EMR/PM software.
• Experience with billing and insurance authorization processes.
• Experience in a pediatric therapy setting is preferred.

Responsibilities

• Run daily eligibility checks for all patients.
• Verify insurance for new and existing patients with changes in coverage.
• Communicate patient finances and insurance coverages clearly to families.
• Explain deductible programs and payment plans to families.
• Add patient flags to reflect payment needs in the system.
• Maintain accurate notes and upcoming appointments in logs.
• Complete insurance authorizations and record in EMR.
• Discuss insurance benefits and payment options with families.
• Coordinate with therapists and rehab director on authorization needs.
• Submit authorization requests promptly and track status.
• Disseminate weekly authorization reports to relevant departments.
• Review pending authorizations and process weekly.
• Route authorization forms to the appropriate therapist and FD.
• Track evaluations for insurance authorization needs.
• Maximize authorization utilization and prevent gaps.
• Generate weekly cancel and Last Seen reports for departments.
• Communicate insurance changes to therapists and billing staff.
• Run End of Day report and distribute to staff.

Skills

Billing & Insurance

EMR/PM Software

Pediatric experience

Tools

EMR System

Job description

Description

We looking for an experienced Billing & Insurance Authorization Specialist to join our busy pediatric therapy practice. The billing specialist will be responsible for a variety of tasks within the revenue and claim cycle to improve the revenue of the practice. Applicant must have experience utilizing Electronic Medical Records/Practice Management software.

Who are we:

Tender Touch Therapy is a woman-owned and therapist owned company that provides high quality pediatric physical, occupational, and speech language therapy services. As a comprehensive team, we implement creative and effective treatment strategies in order to maximize functional independence and achieve patient-specific goals. We will advocate on behalf of each child and their family to enhance well-being and improve lifelong wellness.

Purpose:

Empowering children to change their world one ability at a time.

Location:

Mount Pleasant, WI

Status:

Temporary position, Full Time and/or Part Time

Hours:

Flexible; Monday-Friday, 7:30am-6pm.

SUB-PRODUCTS:

• Run Daily eligibility checks for all patients
• Insurance verifications for all new and existing patients with changes in insurance
• Patient finances and insurance coverages are communicated and planned for accordingly
• Deductible program plan is planned and well communicated with families
• Adding patient flags to patient accounts to reflect payment needs
• Appropriate notes are kept in the communication logs as well as upcoming appointments in regards to family communications.
• Communicate patient services needs to the rehab director
• Complete insurance authorizations and record appropriately in EMR
• Providing insurance information and being a resource for families with regard to their benefits or insurance plan.
• Discuss insurance benefits with families and educate them accordingly about payment plans and co-pays
• Discuss cash based programming with families as needed
• Keep therapists updated on insurance changes, authorization changes and authorization needs
• Submit authorization requests in a timely manner
• PA tracking and communication with therapists as needed
• Bi-weekly auth report disseminated to departments
• Pending auth report reviewed and processed weekly
• Routing authorization approval forms to FD and treating therapist
• Evaluation tracking by week for purposes of insurance authorization needs and follow up for scheduling
• Maximize authorization utilization
• Run and upload weekly cancel report
• Run and upload Last Seen report to department leads
• Contact therapists regarding insurance/scheduling questions
• Notify treating therapists and billing about a change in insurance
• Run End of Day report and distribute to staff

STATISTICS:

• New patients which are informed of insurance benefits and sign the “patient responsibility disclaimer”
• Percentage of authorization utilization for each child/discipline
• Cancellation and Show rate of full clinic (considering the procedures of the FD as well as clinic procedures)
• Scheduled evaluations that show versus NS their appointment
• Scheduled and attend evaluations for the clinic
• Hold versus active patients?
• Visits seen per month
• Percent of arrival

SUB-STATISTICS:

• Monthly dropouts as a result of insurance coverage
• Advanced scheduling of visits
• Percent of Arrival
• Friends and family referral
• Internal referrals
• Progress in the GDP (Growth Development Plan)
• Weekly advanced scheduling
• Positive parent questionnaire
• Call back referrals