Medicare CQ Specialist: Therapy Authorization Expert

ETHOS THERAPY SOLUTIONS, INC; Center Square (PA); On-site; USD 29,000 - 32,000; Full time

Job summary

Ethos Therapy Solutions, Inc. is seeking a Medicare Continued Qualification (CQ) Specialist in Blue Bell, PA. The role focuses on obtaining all necessary insurance documentation to continue medically necessary therapy and to facilitate smooth billing processes.

You will work with patients, caregivers, providers and payers to minimize denials, ensure compliance with Medicare policies, and support timely reauthorization of coverage as therapy progresses.

Qualifications

• High school diploma or equivalent; additional healthcare admin or billing education preferred.
• Direct Medicare experience required.
• Experience with insurance verification in medical settings.
• Knowledge of CPT/ICD-10, HIPAA compliance, and various insurance plans.
• Proficient in EHR systems, insurance databases, and billing software.
• Strong communication, organization, and customer service skills.

Responsibilities

• Obtain documentation required by patient’s insurance provider to continue therapy.
• Coordinate continued therapy and billing processes; minimize payer burden.
• Prevent denials and ensure support for claims throughout the treatment course.
• Communicate with patients, providers, and payors to obtain and verify coverage.
• Collaborate with billing to ensure accurate and timely claim submissions.
• Maintain audit-ready files and compliant documentation.

Skills

Strong communication skills

Attention to detail

Customer service

Team collaboration

Education

High school diploma or equivalent

Healthcare admin / medical billing education preferred

Tools

EHR systems

Billing software

Insurance databases

Job description

Ethos Therapy Solutions, Inc. is seeking a Medicare Continued Qualification (CQ) Specialist in Blue Bell, PA. The role focuses on obtaining all necessary insurance documentation to continue medically necessary therapy and to facilitate smooth billing processes.

You will work with patients, caregivers, providers and payers to minimize denials, ensure compliance with Medicare policies, and support timely reauthorization of coverage as therapy progresses.