What are the responsibilities and job description for the Insurance Authorization Specialist position at Tender Touch Therapy, LLC?
Description
Insurance Authorization Specialist
Mission Statement: Tender Touch Therapy 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: Assist families with insurance, scheduling, coordination of services, ensuring full plan of care is executed throughout the course of their treatment cycle.
Goal: Maximize patient’s access to recommended and required treatment through coordination of services and payor sources. Maximize evaluations completed on new patient intake, scheduling and access to prescribed or needed services for patients to progress their skills to maximize independence with maximum utilization of insurance or payment benefits.
Hours: Monday-Friday, No weekends required!
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
Salary : $17 - $22
