PT/OT Referral Authorization Specialist

Excel Orthopaedic Specialists • Woburn, MA

28d • $20 - $25

About The Position

Excel Orthopaedic Specialists in Woburn is hiring a Referral/Authorization Specialist to join its expanding team at a busy orthopedic practice. The role processes referrals and prior authorizations to help ensure patient visits and procedures are covered by various payers. The specialist reviews therapy schedules, verifies patient eligibility, processes and tracks referrals and authorizations, documents work in eCW, and communicates with patients, payers, providers, and leadership. The role also participates in process improvement, educates teams on updated guidelines and processes, attends staff meetings and continuing education, and completes other tasks as directed by management.

Requirements

• High school diploma required.
• Minimum of two years’ experience in medical and/or rehabilitation billing, referrals, or prior authorizations.
• Knowledge of medical terminology.
• Ability to handle a high volume of calls and claims in a fast-paced environment.
• Excellent verbal and written communication skills.
• Strong computer skills, including experience with EMR and Microsoft Office.

Nice To Haves

• Bachelor’s degree in a related field preferred.

Responsibilities

• Proactively review OT and PT therapy schedules to determine which patients need referrals or prior authorizations.
• Verify patient eligibility, including insurance, workers’ compensation, and motor vehicle accident coverage.
• Prepare, process, and track referrals and prior authorizations through various payer systems, documenting all work in eCW according to protocol.
• Make follow-up calls to patients and payers, including insurance companies and workers’ compensation contacts.
• Respond to questions and requests from leadership, providers, payers, and patients.
• Communicate professionally and use problem-solving skills with providers and leadership.
• Participate in process improvement and educate teams on updated guidelines and processes.
• Complete other tasks as directed by management.
• Attend staff meetings and continuing education.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED