Insurance Authorization Specialist

Shelby American, Inc.; Sturtevant (WI); On-site; USD 40,000 - 70,000; Full time

Job summary

Join a dedicated team as an Insurance Authorization Specialist, where you will play a vital role in maximizing patient access to essential therapies. This position focuses on assisting families with insurance processes, ensuring that treatment plans are executed efficiently, and advocating for each child's needs. You'll conduct insurance verifications, communicate financial options, and maintain detailed records to support the rehab director and therapists. If you are passionate about helping families navigate their insurance benefits and want to contribute to improving children's well-being, this is the perfect opportunity for you. Enjoy a Monday to Friday schedule with no weekends required, and be part of a mission-driven organization that values your contributions.

Qualifications

• Experience in insurance verification and patient coordination is essential.
• Strong communication skills to educate families about insurance.

Responsibilities

• Conduct insurance verifications and eligibility checks for patients.
• Communicate patient service needs and maintain accurate records.
• Maximize authorization utilization and coordinate patient finances.

Skills

Insurance Verification

Patient Coordination

Communication Skills

Financial Planning

Education

High School Diploma

Associate Degree in Healthcare Administration

Tools

Electronic Medical Records (EMR)

Job description

Description

Insurance Authorization Specialist

Mission Statement: Tender Touch Therapy 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: Assist families with insurance, scheduling, coordination of services, ensuring full plan of care is executed throughout the course of their treatment cycle.

Goal: Maximize patient’s access to recommended and required treatment through coordination of services and payor sources. Maximize evaluations completed on new patient intake, scheduling and access to prescribed or needed services for patients to progress their skills to maximize independence with maximum utilization of insurance or payment benefits.

Hours: Monday-Friday, No weekends required!

Location: This position is based out of our Mount Pleasant, Wisconsin location. This is not a remote position.

Responsibilities:

1. Run daily eligibility checks for all patients.
2. Conduct insurance verifications for all new and existing patients with changes in insurance.
3. Communicate and plan for patient finances and insurance coverages accordingly.
4. Develop and communicate deductible program plans with families.
5. Add patient flags to accounts to reflect payment needs.
6. Maintain appropriate notes in communication logs and regarding upcoming appointments.
7. Communicate patient service needs to the rehab director.
8. Complete insurance authorizations and record appropriately in EMR.
9. Provide insurance information and be a resource for families regarding their benefits or insurance plans.
10. Discuss insurance benefits and educate families about payment plans and co-pays.
11. Discuss cash-based programming with families as needed.
12. Keep therapists updated on insurance changes, authorization changes, and needs.
13. Submit authorization requests in a timely manner.
14. Track PA and communicate with therapists as needed.
15. Disseminate bi-weekly authorization reports to departments.
16. Review and process pending authorization reports weekly.
17. Route authorization approval forms to FD and treating therapists.
18. Track evaluations by week for insurance authorization needs and scheduling follow-up.
19. Maximize authorization utilization.
20. Run and upload weekly cancel reports.
21. Run and upload Last Seen reports to department leads.
22. Contact therapists regarding insurance/scheduling questions.
23. Notify treating therapists and billing about changes in insurance.
24. Run End of Day report and distribute to staff.

Statistics:

1. New patients informed of insurance benefits who sign the “patient responsibility disclaimer.”
2. Percentage of authorization utilization for each child/discipline.
3. Cancellation and show rate of full clinic.
4. Scheduled evaluations that show versus no-show appointments.
5. Scheduled and attended evaluations for the clinic.
6. Hold versus active patients.
7. Visits seen per month.
8. Percent of arrival.