Hybrid insurance & billing specialist (part-time)

Benefits:

• 401(k)
• Flexible schedule

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

Required

• 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

Preferred

• 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