Job Title: Billing and Insurance Specialist
Department: Revenue Cycle Management / Administration
Reports To: Clinic owners
Position Type: Part time, hourly position
We are seeking a proactive Billing and Insurance Specialist to manages the full-cycle revenue loop for our outpatient physical therapy practice. You will secure pre-authorizations, submit clean insurance claims, and resolve code-specific denials to protect clinic revenue. This role directly impacts clinical operations by ensuring patient accounts stay accurate and transparent.
Essential Core Responsibilities: Insurance Verification & Pre-Authorization
- Verify comprehensive patient physical therapy benefits via online payer portals and phone contact.
- Secure initial pre-authorizations and required tracking approvals from commercial networks, Medicare, and workers' compensation carriers.
- Track physical therapy utilization thresholds, including total visit allocations and hard therapy cap rules.
- Update Electronic Medical Record (EMR) databases immediately with explicit co-pay, co-insurance, and deductible breakdowns.
Revenue Cycle, Posting, & Denial Management
- Interpret and post complex Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
- Reconcile daily payment ledgers, noting structural underpayments or outright insurance denials.
- Research, correct, and appeal denied or rejected claims within strict carrier-allotted windows.
- Audit weekly accounts receivable aging reports to capture and resolve overdue insurance payments.
Patient Relations & Financial Support
- Act as the dedicated, primary phone and in-person point of contact for patient billing concerns.
- Explain complex therapy coverage terms, payment expectations, and EOB breakdowns clearly to families.
- Create itemized patient invoices and establish authorized clinic payment plans for self-pay accounts.
- Coordinate directly with front-desk staff to streamline regular over-the-counter co-pay collections.
Required Qualifications & SkillsExperience & Education
- Education: High school diploma or equivalent; formal medical billing certificate or degree preferred.
- Experience: Preferred minimum of 2 years of active medical billing experience, ideally inside an outpatient physical therapy facility.
- Systems: Advanced operational proficiency utilizing specialized physical therapy EMR software .
Specialized Knowledge & Soft Skills
- Comprehensive structural knowledge of commercial insurance networks, Medicare, Medicaid, and workers' compensation guidelines.
- Mastery of medical-legal standards, specifically HIPAA compliance laws regarding data security.
- Exceptional attention to detail to catch coding mismatches and structural data entry errors.
- Strong, empathetic communication style to navigate difficult financial conversations with patients.
Job Type: Part-time
Pay: $18.00 - $20.75 per hour
Work Location: In person
