Hybrid Insurance & Billing Specialist (Part-Time)

FYZICAL Therapy & Balance Centers - Concord, NC; Concord (NC); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

401(k)

Flexible schedule

Job summary

FYZICAL Therapy & Balance Centers - Concord, NC is seeking a dedicated Insurance Verification and Billing Specialist to own the clinic’s insurance cycle. You will verify coverage, secure authorizations, post payments, and work denials to keep care uninterrupted.

This role collaborates with front desk, uses payer portals, and supports accurate claims with CPT/ICD-10 coding, while maintaining HIPAA standards and providing clear communication with patients and payers.

Qualifications

• 2+ years medical insurance verification and billing experience.
• Working knowledge of CPT/ICD-10, EOBs/ERAs, and payer portals (Availity, NaviNet, etc.).
• Strong understanding of Medicare and commercial payer rules.
• Organized, self-directed, comfortable working independently on limited hours.
• HIPAA-compliant private workspace, reliable internet, own computer.

Responsibilities

• Insurance verification: confirm active coverage and eligibility for new patients and plan changes, 48+ hours before the evaluation.
• Benefit verification: document PT outpatient benefits and flag patient responsibility to front desk.
• Authorizations: obtain prior auths and re-auths; track approved visits and expiration dates.
• Claims: review charges for coding/modifier accuracy and submit clean claims timely.
• Payment posting: post ERAs/EOBs and reconcile against expected reimbursement.
• Denials & appeals: research denials, correct and resubmit, write appeals.
• AR follow-up: work aging reports, resolve stalled claims by phone and payer portal.
• Payer communication: clinic's contact with commercial, Medicare, Medicare Advantage, Medicaid, and workers' comp/auto payers.
• Patient balances: support patient statements and answer billing questions.
• Reporting: weekly update — verifications done, auths pending, denials worked, AR movement.

Skills

Insurance verification

Medical billing

CPT/ICD-10

Payer portals

HIPAA compliance

Tools

WebPT

Raintree

Prompt

Availity

NaviNet

Job description

Benefits:

• 401(k)
• Flexible schedule

Position Summary

Owns the insurance cycle for an outpatient physical therapy clinic: verifying coverage before patients are seen, securing authorizations, getting clean claims out, and working denials and aging AR until paid. Works with the clinic's front desk/scheduling team and reports to the Managing Partner.

Key Responsibilities

• Insurance verification: confirm active coverage and eligibility for new patients and plan changes, 48+ hours before the evaluation.
• Benefit verification: document PT outpatient benefits — deductible/met, copay/coinsurance, OOP max, visit limits, auth/referral requirements — and flag patient responsibility to the front desk.
• Authorizations: obtain prior auths and re-auths; track approved visits and expiration dates so care isn't interrupted.
• Claims: review charges for coding/modifier accuracy (CPT, ICD-10, GP/KX/59) and submit clean claims timely.
• Payment posting: post ERAs/EOBs and reconcile against expected reimbursement.
• Denials & appeals: research denials/rejections, correct and resubmit, write appeals.
• AR follow-up: work aging reports, prioritizing 60/90+ day balances; resolve stalled claims by phone and payer portal.
• Payer communication: clinic's point of contact with commercial, Medicare, Medicare Advantage, Medicaid, and workers' comp/auto payers.
• Patient balances: support patient statements and answer billing questions.
• Reporting: brief weekly update — verifications done, auths pending, denials worked, AR movement, items needing owner decisions.

Qualifications

Required

• 2+ years medical insurance verification and billing experience
• Working knowledge of CPT/ICD-10, EOBs/ERAs, and payer portals (Availity, NaviNet, etc.)
• Strong understanding of Medicare and commercial payer rules
• Organized, self-directed, comfortable working independently on limited hours
• HIPAA-compliant private workspace, reliable internet, own computer

Preferred

• Outpatient PT/rehab billing (KX modifier, 8-minute rule, plan-of-care certification)
• PT EMR/billing systems (WebPT, Raintree, Prompt, etc.)
• Workers' comp and auto/PI claims
• CPC, CPB, or similar certification

Success Measures

• 100% of new patients verified before first visit
• Zero missed or lapsed authorizations
• Clean claim rate 95%+
• Steady reduction in 90+ day AR
• Denials worked within 7 business days