Hybrid Insurance & Billing Specialist (Part-Time)

Position Summary

Owns the insurance cycle for an outpatient physical therapy clinic: verifying coverage before patients are seen, securing authorizations, getting clean claims out, and working denials and aging AR until paid. Works with the clinic's front desk/scheduling team and reports to the Managing Partner.

Key Responsibilities

•     Insurance verification: confirm active coverage and eligibility for new patients and plan changes, 48+ hours before the evaluation.

•     Benefit verification: document PT outpatient benefits — deductible/met, copay/coinsurance, OOP max, visit limits, auth/referral requirements — and flag patient responsibility to the front desk.

•     Authorizations: obtain prior auths and re-auths; track approved visits and expiration dates so care isn't interrupted.

•     Claims: review charges for coding/modifier accuracy (CPT, ICD-10, GP/KX/59) and submit clean claims timely.

•     Payment posting: post ERAs/EOBs and reconcile against expected reimbursement.

•     Denials & appeals: research denials/rejections, correct and resubmit, write appeals.

•     AR follow-up: work aging reports, prioritizing 60/90+ day balances; resolve stalled claims by phone and payer portal.

•     Payer communication: clinic's point of contact with commercial, Medicare, Medicare Advantage, Medicaid, and workers' comp/auto payers.

•     Patient balances: support patient statements and answer billing questions.

•     Reporting: brief weekly update — verifications done, auths pending, denials worked, AR movement, items needing owner decisions.

Qualifications

•     2+ years medical insurance verification and billing experience

•     Working knowledge of CPT/ICD-10, EOBs/ERAs, and payer portals (Availity, NaviNet, etc.)

•     Strong understanding of Medicare and commercial payer rules

•     Organized, self-directed, comfortable working independently on limited hours

•     HIPAA-compliant private workspace, reliable internet, own computer

•     Outpatient PT/rehab billing (KX modifier, 8-minute rule, plan-of-care certification)

•     PT EMR/billing systems (WebPT, Raintree, Prompt, etc.)

•     Workers' comp and auto/PI claims

•     CPC, CPB, or similar certification

Success Measures

•     100% of new patients verified before first visit

•     Zero missed or lapsed authorizations

•     Clean claim rate 95%+

•     Steady reduction in 90+ day AR

•     Denials worked within 7 business days