Authorization Specialist (Therapy Services) - HOUSTON PHYSICIANS' HOSPITAL

JOB SUMMARY

Responsible for verifying benefits prior to procedures and notifying the patient of financial responsibility.  Maintains information in an organized manner and obtains pre-authorization for procedures as required by the Insurance Companies.

 Reviews financial obligation with patient and family member.  Responsible for sending proper documentation to billing department.  Prequalifies third party coverage of scheduled procedure.  Assists in the collection and follow-up of patient survey responses. 

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 QUALIFICATIONS

• High School graduate required
• Four years of medical facility or medical business office experience required
• Experience in customer relations or teaching preferred
• Experience in third party payer requirements preferred
• Automated billing systems experience required
• Training/experience in business office activities preferred
• Requires frequent and constant judgement for timely response to patient questions and concerns.
• Requires language skills adequate for effective written and interpersonal communication in American English.
• Require visual and auditory acuity adequate for frequent use of computers and occasional use of other business office equipment.
• Ability to sit for long periods and to perform desk and office activities.

OCCUPATIONAL EXPOSURE

Category III exposure to bloodborne pathogens may encounter chemical hazards.

RESPONSIBILITIES

•  Registration of Physical Therapy patients in billing system.
• Obtains all demographic information for PT (MOS) referrals.
• Completes data entry of patient’s fee sheets.
• Discusses financial obligations with the patient or family member, explaining their PT Benefits.
• Assists in setting a payment schedule for the patient.
• Manage / processes Managed Outsource Solutions referrals.
• Inputs all referrals on communication board as needed.
• Schedules first initial evaluation for all new referrals as needed.
• Verifies Physical Therapy benefits for the scheduled patients a needed.
• Communicates with each clinic coordinator to ensure all accounts are created and all information is sent to clinics prior to appointment.
• Reports regularly to the PT Business Operations Manager about the status of workflow within systems.
• Maintains a 1 hour turnaround time per patient account.