Position Summary:
The Verification Specialist ensures complete, accurate, and timely verification of insurance benefits for patient registrations (both private clinic and hospital clinic); assists clinic staff with completion of insurance benefit verification for all patient evaluations and re-evaluations. This position is also responsible to pre-certify/pre-authorize outpatient therapy services.
Essential Functions:
• Obtains necessary information to initiate the insurance verification process.
• Contacts insurance companies to verify coverage, limits, etc. as directed by policy.
• Initiates tracking forms for outpatients based on patient benefits available.
• Obtains reports and treatment notes when needed for insurance authorization and payment.
• Assists with outpatient registrations and/or check-ins when needed.
• Prepares daily productivity report and submits it to the business office manager.
• Assists in the preparation of policies and procedures manuals for benefits verification.
• Expands knowledge of insurance benefits and program changes related to Medicare, Medicaid, and commercial carriers by reviewing literature, attending seminars, and taking advantage of continuing education opportunities.
• Communicate and cooperate with clinic personnel.
• Obtain patient, billing and insurance information in order to maintain current and accurate information in patient files and billing system.
• Coordinate with clinic personnel as is necessary to ensure their understanding of patients’ insurance benefits and to secure appropriate reimbursement for services rendered.
• Perform telephonic support for online authorization of therapy services
• Provide direct support to clinic personnel regarding utilization, authorization, and referral activities
• Become proficient in the use of ICD-10 and CPT codes
• Contact clinics with authorization, denial, and appeals process information
• Performs additional duties deemed necessary to the position and its function.
• Assist with end of month corrections on the back end with hospital partners.
Required Skills & Abilities:
• Ability to type 60 words per minute preferred.
• Strong interpersonal, oral (includes telephone skills) and written communication skills.
• Good organizational skills and an ability to prioritize to meet deadlines.
• Complete understanding of medical reimbursement and terminology.
• Ability to work with disabled individuals.
• Working knowledge of all standard office equipment.
• Working Knowledge of insurance and outpatient billing procedures.
Expanding Access to Quality Care
At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.
As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact.
Let’s go further together and transform care.Join the #PTSLife today!
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