Prior Authorization Specialist

OP Specialty Bracing• US,

1d•$50,000 - $60,000

About The Position

OP Specialty Bracing is growing, and we believe our team is the key to our success. We are hiring a Prosthetic Authorization & Billing Specialist to join our team. If you are a motivated, caring individual who wants to make a difference in the lives of children, we encourage you to apply today! At OP Specialty Bracing, kids are at the heart of everything we do. Our cause is simple: to improve the lives of children with orthopedic conditions and support their families every step of the way. From fractures and clubfoot to cerebral palsy, scoliosis, plagiocephaly, limb loss, and more, our certified clinical team treats the whole child in partnership with their care team. Helping kids is what we do; changing their lives is how we make a difference. OPSB offers specialized pediatric clinics across the country, including in major children’s hospitals, ensuring that every child gets top-notch, kid-focused care. Our pediatric focus means that all our resources, from products to educational videos and print materials, are designed specifically towards the treatment of kids. With a growing library of resources and patient stories, we make the transition to treatment easier for families. We’re not just providing care—we’re pioneering it! Our team is constantly developing new, cutting-edge solutions in pediatric orthotics and prosthetics, because we believe every child deserves the very best. At OP Specialty Bracing, pediatric care is not just something we do—it’s our passion, our purpose, and our promise to the kids we serve.

Requirements

High School Diploma or equivalent required.
2+ years of medical billing, prior authorization, or revenue cycle experience.
Strong understanding of insurance verification, authorization, and reimbursement processes.
Experience working with Medicare, Medicaid, and commercial insurance carriers.
Knowledge of medical terminology, coding, and billing procedures.
Strong math, analytical, and data entry skills.
Excellent organizational, problem-solving, and communication skills.
Proficiency in Microsoft Office (Word, Excel) and medical billing software systems.

Nice To Haves

Orthotics & Prosthetics (O&P), DME, or specialty healthcare billing experience highly preferred.
Experience with Nymbl or similar EMR/billing systems.
Familiarity with denied claims management and appeals processes.

Responsibilities

Verify patient insurance eligibility and benefits.
Submit and manage prior authorizations as required by insurance carriers.
Obtain and maintain all necessary documentation required for authorization and billing.
Understand and communicate patient financial responsibilities including copays, coinsurance, and deductibles.
Collect patient balances and answer patient questions regarding charges and account status.
Build proactive relationships with referral sources, physician offices, and administrative assistants.
Collect and review all information necessary to process insurance claims and patient billing.
Submit accurate claims in accordance with payer requirements and standard billing procedures.
Research, correct, and re-submit rejected or denied claims.
Prepare appeals for denied claims when necessary.
Follow through on outstanding claims, cash applications, delinquent accounts, write-offs, and collection activities.
Work directly with payers to resolve reimbursement and claim issues.
Ensure patient demographic, encounter, and insurance information is entered accurately into the electronic billing system.
Research, administer, and resolve billing discrepancies and collection issues.
Support resolution of self-pay balances and payment concerns.
Maintain accurate account documentation and follow-up notes.
Monitor aging accounts and assist with collection efforts as appropriate.
Ensure compliance with company policies, HIPAA regulations, and payer guidelines.
Maintain confidentiality of patient and financial information.
Ensure documentation accuracy and completeness for billing and reimbursement purposes.