What are the responsibilities and job description for the PT Authorization Specialist - Remote position at Direct Orthopedic Care?
As the PT Authorization Specialist, I report to the Billing Manager. I create a connection with DOC guests and ensure that our value of tenacious caring occurs. I do this by understanding the value of communication, a helpful hand, and the importance of relating to one’s needs.
Lead Outcomes:
- I lead efforts in obtaining authorization and benefit verification for new guests in the Physical Therapy service line.
- Ensure CPT & ICD-10 coding are supported by clinical documentation.
- I lead DOC customer service protocols to ensure the guest receives the required authorization for PT services performed within DOC.
- Manage workflow of the assigned accounts and prioritize issues to meet deadlines for authorization.
- I maintain guest confidentiality and ensure PHI is secure at all times. I maintain a comprehensive knowledge and working understanding of HIPAA regulations and continual compliance.
- Meet monthly key performance indicators.
Core Responsibilities:
- Perform benefit verification and initiate prior authorizations (when required) on new PT guests.
- Perform stat requests from clinic within same business day, or the following business if received after your normal working hours.
- Follow up on prior authorizations submitted but not received or approved, in 72 hours (dependent on payer); Work to find solutions for authorization denials.
- Review Providers notes to ensure all services provided are documented and adequate for authorization submission.
- Obtain/Maintain knowledge of PT Authorization guidelines/policies to remain in compliance with the highest standard of authorization practices.
- Bill PT charges for assigned clinics within 48 business hours from DOS to align with RCM department KPIs (on a back-up basis).
- Brings authorization denial issues to RCM Billing Manager for review.
- Assists with clinic correspondence tasks, as needed
- Assists with guest emails/RCM guest rollover calls, as needed.
- Responds to emails/Teams chats in a timely manner.
- Attending assigned clinic check-ins weekly to remain up to date on clinical happenings and to update clinics as necessary with billing information.
Competencies:
- Familiarization and understanding of CPT & ICD-10 codes
- Ability to read a clinical note and extrapolate data needed for authorization approval/billing processes.
- Extensive knowledge of health insurance billing and processes, provider plans and payer contracts/worker’s compensation are a plus
- My behaviors and standards model DOC’s Core Values and deliver a service experience that is unrivaled.
- My work shows great attention to detail.
- My leadership is proactive.
- Understanding/Experience using PM/EMR systems
- I use active listening skills.
- My behavior is enthusiastic.
- I enjoy working as part of a team.
- I am flexible and adaptable.
- I am able to lift up to 50lbs.
- I am proficient in computer skills.
