Physical Therapy Authorization Specialist

Socket.dev; Addison (TX); On-site; USD 48,000 - 66,000; Full time

Job summary

Socket.dev is seeking a PT Authorization Specialist to join our team supporting Physical Therapy services. You will lead benefit verifications, initiate prior authorizations, and ensure documentation supports CPT/ICD-10 coding while maintaining PHI confidentiality.

You will collaborate with clinics, respond to payer requests, and maintain timely authorization workflows to meet RCM KPIs. HIPAA compliance and strong EMR proficiency are essential for success in this role.

Qualifications

• Familiarity with CPT and ICD-10 coding for authorization.
• Strong knowledge of health insurance billing and payer contracts.
• Ability to interpret clinical notes for authorization and billing.
• Experience with EMR systems and RCM processes.
• Comfort with fast-paced environment and deadlines.

Responsibilities

• Perform benefit verification and initiate prior authorizations for new PT guests.
• Follow up on prior authorizations and resolve denials.
• Review Providers notes to ensure documentation supports authorization.
• Bill PT charges within 48 business hours from date of service.
• Attend clinic check-ins and update billing information as needed.
• Respond to emails/Teams chats promptly.

Skills

CPT & ICD-10 codes

HIPAA compliance

EMR systems

Communication

Attention to detail

Tools

EMR software

Billing software

Job description

As the PT Authorization Specialist, I report to the Authorization Supervisor. I create a connection with DOC guests and ensure that our value of tenacious caring occurs. I do this by understanding the value of communication, a helpful hand, and the importance of relating to one’s needs.

Lead Outcomes

• I lead efforts in obtaining authorization and benefit verification for new guests in the Physical Therapy service line.
• Ensure CPT & ICD-10 coding are supported by clinical documentation.
• I lead DOC customer service protocols to ensure the guest receives the required authorization for PT services performed within DOC.
• Manage workflow of the assigned accounts and prioritize issues to meet deadlines for authorization.
• I maintain guest confidentiality and ensure PHI is secure at all times. I maintain a comprehensive knowledge and working understanding of HIPAA regulations and continual compliance.
• Meet monthly key performance indicators.

Core Responsibilities

• Perform benefit verification and initiate prior authorizations (when required) on new PT guests.
• Perform stat requests from clinic within same business day, or the following business if received after your normal working hours.
• Follow up on prior authorizations submitted but not received or approved, in 72 hours (dependent on payer); Work to find solutions for authorization denials.
• Review Providers notes to ensure all services provided are documented and adequate for authorization submission.
• Obtain/Maintain knowledge of PT Authorization guidelines/policies to remain in compliance with the highest standard of authorization practices.
• Bill PT charges for assigned clinics within 48 business hours from DOS to align with RCM department KPIs (on a back-up basis).
• Brings authorization denial issues to RCM Billing Manager for review.
• Assists with clinic correspondence tasks, as needed
• Assists with guest emails/RCM guest rollover calls, as needed.
• Responds to emails/Teams chats in a timely manner.

• Attending assigned clinic check-ins weekly to remain up to date on clinical happenings and to update clinics as necessary with billing information.

Competencies

• Familiarization and understanding of CPT & ICD-10 codes
• Ability to read a clinical note and extrapolate data needed for authorization approval/billing processes.
• Extensive knowledge of health insurance billing and processes, provider plans and payer contracts/worker’s compensation are a plus
• My behaviors and standards model DOC’s Core Values and deliver a service experience that is unrivaled.
• My work shows great attention to detail.
• My leadership is proactive.
• Understanding/Experience using PM/EMR systems
• I use active listening skills.
• My behavior is enthusiastic.
• I enjoy working as part of a team.
• I am flexible and adaptable.
• I am able to lift up to 50lbs.
• I am proficient in computer skills.