Billing & Insurance Authorization Specialist

We looking for an experienced Billing & Insurance Authorization Specialist to join our busy pediatric therapy practice. The billing specialist will be responsible for a variety of tasks within the revenue and claim cycle to improve the revenue of the practice. Applicant must have experience utilizing Electronic Medical Records/Practice Management software.

Who are we: Tender Touch Therapy is a woman-owned and therapist owned company that provides high quality pediatric physical, occupational, and speech language therapy services. As a comprehensive team, we implement creative and effective treatment strategies in order to maximize functional independence and achieve patient-specific goals. We will advocate on behalf of each child and their family to enhance well-being and improve lifelong wellness.

Purpose: Empowering children to change their world one ability at a time.

Location: Mount Pleasant, WI

Status: Temporary position, Full Time and/or Part Time

Hours: Flexible; Monday-Friday, 7:30am-6pm.

SUB-PRODUCTS:

• Run Daily eligibility checks for all patients
• Insurance verifications for all new and existing patients with changes in insurance
• Patient finances and insurance coverages are communicated and planned for accordingly
• Deductible program plan is planned and well communicated with families
• Adding patient flags to patient accounts to reflect payment needs
• Appropriate notes are kept in the communication logs as well as upcoming appointments in regards to family communications.
• Communicate patient services needs to the rehab director
• Complete insurance authorizations and record appropriately in EMR
• Providing insurance information and being a resource for families with regard to their benefits or insurance plan.
• Discuss insurance benefits with families and educate them accordingly about payment plans and co-pays
• Discuss cash based programming with families as needed
• Keep therapists updated on insurance changes, authorization changes and authorization needs
• Submit authorization requests in a timely manner
• PA tracking and communication with therapists as needed
• Bi-weekly auth report disseminated to departments
• Pending auth report reviewed and processed weekly
• Routing authorization approval forms to FD and treating therapist
• Evaluation tracking by week for purposes of insurance authorization needs and follow up for scheduling
• Maximize authorization utilization
• Run and upload weekly cancel report
• Run and upload Last Seen report to department leads
• Contact therapists regarding insurance/scheduling questions
• Notify treating therapists and billing about a change in insurance
• Run End of Day report and distribute to staff

STATISTICS:

• New patients which are informed of insurance benefits and sign the “patient responsibility disclaimer”
• Percentage of authorization utilization for each child/discipline
• Cancellation and Show rate of full clinic (considering the procedures of the FD as well as clinic procedures)
• Scheduled evaluations that show versus NS their appointment
• Scheduled and attend evaluations for the clinic
• Hold versus active patients?
• Visits seen per month
• Percent of arrival

SUB-STATISTICS:

• Monthly dropouts as a result of insurance coverage
• Advanced scheduling of visits
• Percent of Arrival
• Friends and family referral
• Internal referrals
• Progress in the GDP (Growth Development Plan)
• Weekly advanced scheduling
• Positive parent questionnaire
• Call back referrals