Therapy Authorizations - PT/OT

South Florida Orthopaedics & Sports Medicine PA•Stuart, FL

About The Position

Responsible for obtaining and managing insurance authorizations for Physical Therapy (PT) and Occupational Therapy (OT) services. Verifies benefits, tracks visit limits, and communicates authorization status to clinical and administrative teams. Serves as backup to Therapy Services Schedulers to support patient access and continuity of care.

Requirements

Experience with insurance authorizations; PT/OT experience preferred.
Experience with EMR/PM systems; NextGen preferred.
Strong attention to detail and organizational skills.
Ability to work in a fast-paced environment.
Effective communication and customer service skills.
Strong data entry and computer skills.
Primarily sedentary; use of standard office equipment.
Occasional lifting or carrying under 25 lbs.

Responsibilities

Obtain initial and re-authorizations for PT/OT services per payer requirements.
Track authorization expirations and visit limits; request re-authorizations timely.
Monitor NextGen tasks and therapy schedules for authorization needs.
Respond to STAT and urgent authorization requests.
Verify therapy benefits including copays, deductibles, and visit caps.
Enter authorization and benefit information into NextGen and Clearwave.
Notify patients of financial responsibility when applicable.
Submit medical records and documentation to payers as requested.
Coordinate peer-to-peer reviews when required.
Communicate authorization status to therapists, schedulers, and patients.
Document all authorization activity in NextGen per protocol.
Provide backup support to PT/OT scheduling, including evaluations and no-shows.
Coordinate with Therapy Services, Billing, and Front Desk staff.
Assist with outside therapy referrals as needed.
Maintain knowledge of payer rules and ensure compliance with Medicare, Medicaid, Workers’ Compensation, auto, and commercial plans.
Maintain HIPAA compliance.
Perform other duties as assigned.