Authorization Representative / Insurance Verification Specialist

Position Summary

The Authorization Representative / Insurance Verification Specialist is responsible for verifying insurance eligibility and benefits, obtaining prior authorizations, ensuring accurate patient insurance information, and coordinating with physicians, insurance companies, and clinical staff to facilitate timely patient care. This position plays a critical role in minimizing claim denials and ensuring reimbursement for outpatient therapy services.

Essential Duties and ResponsibilitiesInsurance Verification

• Verify patient insurance eligibility and benefits before services are rendered.
• Confirm deductible, co-pay, co-insurance, out-of-pocket maximums, and visit limitations.
• Verify therapy benefits including Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST).
• Identify payer-specific authorization requirements.
• Document verification information accurately within the EMR.

Prior Authorizations

• Submit initial authorization requests to insurance companies.
• Obtain authorizations for evaluations, treatment visits, and re-certifications.
• Track authorization expiration dates and remaining approved visits.
• Submit requests for additional visits before authorization expires.
• Communicate authorization status to therapists and scheduling staff.
• Resolve authorization denials by submitting appeals or additional documentation when appropriate.

Patient Registration

• Collect accurate demographic and insurance information.
• Scan insurance cards and required documentation.
• Verify physician referrals and signed orders.
• Ensure all required intake forms are completed.

Communication

• Serve as liaison between physicians, insurance companies, and patients.
• Notify patients of insurance coverage, co-pays, deductibles, and financial responsibility.
• Communicate authorization delays to clinical staff.
• Follow up with physician offices regarding referrals and documentation.

Documentation

• Maintain accurate authorization logs.
• Update EMR with authorization numbers, approved visits, effective dates, and expiration dates.
• Ensure documentation supports medical necessity requirements.

Revenue Cycle Support

• Reduce claim denials related to eligibility and authorization issues.
• Assist billing department in resolving insurance discrepancies.
• Monitor payer policy updates affecting outpatient therapy services.
• Participate in quality assurance and compliance activities.

Qualifications

Education

• High School Diploma or GED required.
• Associate degree preferred.

Experience

• Minimum one (1) year of insurance verification or prior authorization experience.
• Experience in outpatient rehabilitation, physical therapy, occupational therapy, speech therapy, or medical office preferred.
• Knowledge of Medicare, Medicaid, commercial insurance, and managed care plans.

Knowledge, Skills, and Abilities

• Knowledge of medical terminology.
• Understanding of insurance eligibility and benefit verification.
• Familiarity with CPT, ICD-10, and therapy authorization requirements.
• Strong organizational and multitasking skills.
• Excellent communication and customer service skills.
• Proficiency in EMR/EHR systems and Microsoft Office.
• Ability to prioritize multiple authorization requests while meeting deadlines.
• Strong attention to detail and accuracy.

Physical Requirements

• Prolonged sitting and computer use.
• Frequent telephone communication.
• Occasional lifting up to 20 pounds.
• Ability to work in a fast-paced outpatient clinical environment.

Preferred Qualifications

• Experience with outpatient physical therapy billing and authorizations.
• Knowledge of Medicare therapy regulations.
• Experience using EMR systems such as WebPT, Prompt, Raintree, or similar therapy software.
• Bilingual (English/Spanish) preferred.

Performance Expectations

• Verify insurance before initial evaluation.
• Obtain authorizations prior to treatment whenever required.
• Maintain accurate documentation with minimal errors.
• Meet authorization turnaround timelines.
• Reduce authorization-related claim denials.
• Provide professional customer service to patients, providers, and insurance representatives.

Pay: $14.00 - $16.00 per hour

Benefits:

• Health insurance
• Paid time off

Experience:

• Insurance verification: 1 year (Required)

Language:

• SPANISH ENGLISH (Required)

Ability to Commute:

• El Paso, TX 79936 (Required)

Work Location: In person