Physical Therapy Authorization Specialist

Direct-Orthopedic-Care; Addison (TX); On-site; USD 28,000 - 30,000; Full time

Job summary

Direct-Orthopedic-Care in Addison, TX is seeking a Physical Therapy Authorization Specialist in a full-time clerical role. You will verify benefits and obtain prior authorizations for new PT guests, ensuring CPT & ICD-10 coding is supported by clinical documentation and PHI remains secure under HIPAA.

You will manage workflows, meet billing KPIs, and provide timely clinic communications to support access to PT services.

Qualifications

• Perform benefit verification and initiate prior authorizations on new PT guests.
• Ensure CPT & ICD-10 coding is supported by clinical documentation.
• Maintain PHI security and HIPAA compliance.
• Respond to emails/Teams chats in a timely manner.
• Attend clinic check-ins to stay updated on clinical billing information.

Responsibilities

• Lead authorization and benefit verification efforts for new PT guests.
• Follow up on prior authorizations within the required timeframes; address denials.
• Review provider notes to ensure services are documented for authorization.
• Bill PT charges within 48 business hours from date of service.
• Assist with clinic correspondence and guest communications as needed.
• Maintain knowledge of CPT & ICD-10 codes.

Skills

Benefit verification

Prior authorizations

CPT & ICD-10 coding

HIPAA compliance

Customer service

Communication

EMR systems familiarity

Tools

EMR systems

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Physical Therapy Authorization Specialist

Full Time Clerical Addison, TX, US

Salary Range: $20.00 To $22.00 Hourly

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.
• 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