Insurance Specialist

• Receives and processes referrals for outpatient PT and OT services.
• Contacts insurance companies to verify coverage for therapy services.
• Makes appropriate referrals to financial counseling for uninsured and underinsured patients.
• Assists families with questions regarding the complexities of the healthcare reimbursement process.
• Works with clinical, financial assistance and other staff to obtain clinical and other information needed to complete pre-authorization paperwork, including physician signatures and ICD10 therapy and medical diagnosis codes in a timely manner
• Schedules outpatient therapy evaluations and follow up appointments and proactively mails reminder letters or makes phone calls to optimize patient attendance at therapy visits.
• Maintains records related to patient’s authorized visits and assists therapists with re-authorization as indicated.
• Works with hospital clinical and billing staff as well as insurance companies to assist with resolution of denials for therapy services, including coordination of peer-to-peer reviews with physicians and payers.
• Works with departmental staff to perform audits of therapy charges, to create reports for tracking or trending purposes, and to identify strategies for resolution and prevention of denials.
• Cross-train with other positions as needed to provided coverage and understand overall functions of department.

Education/Experience Requirements:

• High school diploma or equivalent required; two years of college or associate’s degree preferred.
• Certified billing / coding specialist desired.
• Two years insurance pre-certification experience in the health care field required, preferably in Occupational and Physical Therapy.
• Working knowledge of medical terminology, applicable ICD-9, ICD-10, and CPT codes, as well as Texas State Medicaid Programs and Private Insurance processes and procedures.
• Demonstrates professionalism as well as excellent verbal and written communication skills in order to provide the highest level of customer service for both internal and external customers.
• Bilingual skills preferred.