Preauthorization Specialist

Orthopedic Surgery and Sports•Coeur d’Alene, ID

4h•$19 - $24•Onsite

About The Position

The Physical Therapy Prior Authorization Specialist is responsible for obtaining insurance authorizations for outpatient physical and occupational therapy services. This role ensures timely submission, tracking, and follow-up of authorization requests to prevent delays in patient care and reimbursement. The specialist works closely with providers, clinical staff, billing, and insurance payers to support compliance and revenue cycle integrity. Performs other related duties as assigned.

Requirements

High school diploma or equivalent.
Excellent communication and interpersonal skills.
1-3 years of medical insurance authorization or medical billing preferred.
Orthopedic or physical therapy practice experience preferred.
Efficient in the use of standard office equipment, data entry, typing, 10-key skills, and alpha/numerical filing.
Strong understanding of: CPT and ICD-10 coding related to physical and occupational therapy
Medical necessity documentation standards
Commercial and Medicare Advantage prior authorization processes
Familiarity with major payers such as: Blue Cross of Idaho UnitedHealthcare Aetna Blue Cross Blue Shield Cigna
Knowledge of utilization management and therapy visit limits.
Strong attention to detail and organizational skills.
Ability to manage high-volume workflows with strict deadlines.
Effective written and verbal communication skills.
Proficiency with EMR and payer portals.
Regular and predictable attendance is an essential job function.
Majority of the shift is spent sitting.
Frequent reaching, stooping and twisting when filing, accessing records and answering telephone
Ability to lift up to 25 pounds.
Read a variety of printed and handwritten materials, computerized reports, manuals, and correspondence.
Communicates with patients, physicians, families and co-workers in person and on the telephone.
Comply with company policies, procedures, practices and business ethics guidelines.
Complete job required training.
Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
Work in the office during business hours
Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines
Communicate and interact in a respectful and professional manner
Prioritize workload while being flexible to meet the expectations of the daily operations
Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions
Understand and execute a variety of instructions
Work independently with minimal supervision

Nice To Haves

Orthopedic or physical therapy practice experience preferred.

Responsibilities

Verify insurance benefits for physical therapy services.
Determine prior authorization requirements for commercial, Medicare Advantage, Medicaid, and workers’ compensation plans.
Submit prior authorization requests with required clinical documentation.
Track and monitor authorization status to ensure approval before services are rendered.
Follow up with insurance carriers for pending, denied, or partially approved requests.
Communicate authorization determinations to scheduling, therapy staff, and billing teams.
Review and appeal authorization denials when appropriate.
Ensure authorizations reflect accurate CPT codes, ICD-10 diagnoses, frequency, and duration of therapy.
Maintain detailed documentation of all payer communications.
Monitor authorization expiration dates and request extensions as needed.
Stay current on payer-specific guidelines and policy updates.
Maintain HIPAA compliance and protect patient confidentiality.