Authorization and Benefits Specialist
About The Position
Proliance is seeking an experienced Physical Therapy Authorization Specialist to join our fun, collaborative, and patient-focused team. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced healthcare environment and is passionate about helping patients receive the care they need. In this role, you will be responsible for obtaining insurance authorizations, coordinating with payers and providers, and ensuring patients have timely access to physical therapy services. Your work will directly support our mission of delivering exceptional patient care and outstanding outcomes.
Requirements
- High School diploma/GED or equivalent
- Previous experience in Evicore, Availity, Cohere, etc.
- Medicare experience strongly preferred.
- Previous experience obtaining insurance authorizations in a healthcare setting
- Knowledge of insurance benefits, referrals, and authorization processes
- Strong communication and customer service skills
- Ability to manage multiple priorities in a fast-paced environment
- Experience with electronic medical records (EMR) systems preferred
- Attention to detail, excellent organizational and time management skills
- Ability to work both independently and as a team member
- Demonstrated ability to learn quickly and function well in a fast paced, high-pressure environment
- Great interpersonal skills; demonstrating patience, composure and cooperation; working well with all patients, physicians, staff, and other business associates
- Understanding of and adherence to all safety, risk management and precautionary procedures (OSHA/WISHA), including the consistent respect for confidentiality (HIPAA)
- Self-motivated; able to work following specific guidelines and in accordance with detailed instructions; measure self against standard of excellence, overcome obstacles and challenges with little supervision
Responsibilities
- Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage
- Able to triage incoming calls and requests form provider groups/patient for authorization of services, questions, status updates
- Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
- Maintain a working knowledge of health care plan requirements and health plan networks
- Verify and document insurance information as defined by current business practices
- Review Explanation of Benefits (EOB), research denials, rejections and/or excessive reductions
- Ensure appropriate forms are used when requesting adjustments, insurance transfers or other specific account changes
- Prepare, submit and ensure timely claim accuracy for all physician billing to third party insurance carriers either electronically or via hard copy
- Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
- Take inbound calls from patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
- Review and work any credit balances to determine if patient and/or insurance company refund is applicable
- Other duties as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
