South Florida Orthopaedics and Sports Medicine
Therapy Services Authorizations Specialist
South Florida Orthopaedics and Sports Medicine, Stuart, Florida, United States, 34997
Job Type
Full-time
Description
The Therapy Services Authorization Specialist is responsible for obtaining timely insurance authorizations for Physical Therapy (PT) and Occupational Therapy (OT) services, including initial evaluations and re-authorizations. This role verifies patient benefits, monitors visit utilization, and communicates authorization status to clinical and administrative teams. The Specialist also serves as backup to Therapy Services Schedulers to ensure seamless patient access and continuity of care.
Requirements
Duties and Responsibilities:
Obtains initial and re-authorizations for PT/OT services based on payer requirements. Tracks authorization expirations and visit limits, ensuring re-authorization is requested proactively. Monitors NextGen tasks and therapy schedules to identify patients needing authorization. Responds promptly to STAT or urgent requests for authorization. Verifies therapy-specific insurance benefits, including coverage limits, copays, deductibles, and visit caps. Accurately enters benefit and authorization details in NextGen and Clearwave. Notifies patients of financial responsibility when required. Provides medical records and clinical documentation to payers as requested to support medical necessity. Schedules and coordinates peer-to-peer reviews when required. Clearly communicates authorization status (approved, pending, denied) to therapists, schedulers, and patients. Documents all authorization activity in NextGen according to established protocol. Serves as backup to PT/OT Schedulers, including making initial evaluation appointments, rescheduling no-shows, and contacting patients as needed. Collaborates closely with Therapy Services staff, Billing, and Front Desk teams to ensure accurate insurance capture and billing readiness. Assists with outside therapy referrals when applicable, ensuring authorization and documentation requirements are met. Maintains current knowledge of payer policies, therapy coverage rules, and SFO anticipation status. Ensures compliance with Medicare, Medicaid, Workers' Compensation, auto, and commercial plan requirements. Identifies workflow gaps and recommends process improvements to reduce denials and maximize efficiency. Provides accurate, prompt, and professional communication with patients, payers, and internal staff. Maintains confidentiality and HIPAA compliance at all times. Performs other duties as assigned. Essential Skills & Requirements:
Prior experience in insurance authorization for therapy services (PT/OT) strongly preferred. Experience with EMR/PM systems (NextGen preferred) and scheduling workflows. Strong attention to detail and ability to work in a fast-paced, high-volume environment. Excellent communication and customer service skills. Ability to multitask and prioritize under tight deadlines. Strong keyboard/data entry skills. Physical Demands:
Primarily sedentary, sitting. Use of general office equipment (keyboard, telephone, faxing). Occasional lifting, stooping, and carrying less than 25 lbs.
Full-time
Description
The Therapy Services Authorization Specialist is responsible for obtaining timely insurance authorizations for Physical Therapy (PT) and Occupational Therapy (OT) services, including initial evaluations and re-authorizations. This role verifies patient benefits, monitors visit utilization, and communicates authorization status to clinical and administrative teams. The Specialist also serves as backup to Therapy Services Schedulers to ensure seamless patient access and continuity of care.
Requirements
Duties and Responsibilities:
Obtains initial and re-authorizations for PT/OT services based on payer requirements. Tracks authorization expirations and visit limits, ensuring re-authorization is requested proactively. Monitors NextGen tasks and therapy schedules to identify patients needing authorization. Responds promptly to STAT or urgent requests for authorization. Verifies therapy-specific insurance benefits, including coverage limits, copays, deductibles, and visit caps. Accurately enters benefit and authorization details in NextGen and Clearwave. Notifies patients of financial responsibility when required. Provides medical records and clinical documentation to payers as requested to support medical necessity. Schedules and coordinates peer-to-peer reviews when required. Clearly communicates authorization status (approved, pending, denied) to therapists, schedulers, and patients. Documents all authorization activity in NextGen according to established protocol. Serves as backup to PT/OT Schedulers, including making initial evaluation appointments, rescheduling no-shows, and contacting patients as needed. Collaborates closely with Therapy Services staff, Billing, and Front Desk teams to ensure accurate insurance capture and billing readiness. Assists with outside therapy referrals when applicable, ensuring authorization and documentation requirements are met. Maintains current knowledge of payer policies, therapy coverage rules, and SFO anticipation status. Ensures compliance with Medicare, Medicaid, Workers' Compensation, auto, and commercial plan requirements. Identifies workflow gaps and recommends process improvements to reduce denials and maximize efficiency. Provides accurate, prompt, and professional communication with patients, payers, and internal staff. Maintains confidentiality and HIPAA compliance at all times. Performs other duties as assigned. Essential Skills & Requirements:
Prior experience in insurance authorization for therapy services (PT/OT) strongly preferred. Experience with EMR/PM systems (NextGen preferred) and scheduling workflows. Strong attention to detail and ability to work in a fast-paced, high-volume environment. Excellent communication and customer service skills. Ability to multitask and prioritize under tight deadlines. Strong keyboard/data entry skills. Physical Demands:
Primarily sedentary, sitting. Use of general office equipment (keyboard, telephone, faxing). Occasional lifting, stooping, and carrying less than 25 lbs.