Billing and Insurance Specialist for an Outpatient Physical Therapy Clinic

Job Title:

Billing and Insurance Specialist Department:

Revenue Cycle Management /

Administration Reports To:

Clinic owners

Position Type:

Part time, hourly position We are seeking a proactive Billing and Insurance Specialist to manages the full-cycle revenue loop for our outpatient physical therapy practice. You will secure pre-authorizations, submit clean insurance claims, and resolve code-specific denials to protect clinic revenue. This role directly impacts clinical operations by ensuring patient accounts stay accurate and transparent.

Essential Core Responsibilities:

Insurance Verification & Pre-Authorization Verify comprehensive patient physical therapy benefits via online payer portals and phone contact. Secure initial pre-authorizations and required tracking approvals from commercial networks, Medicare, and workers' compensation carriers. Track physical therapy utilization thresholds, including total visit allocations and hard therapy cap rules. Update Electronic Medical Record (EMR) databases immediately with explicit co-pay, co-insurance, and deductible breakdowns. Revenue Cycle, Posting, & Denial Management Interpret and post complex Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs). Reconcile daily payment ledgers, noting structural underpayments or outright insurance denials. Research, correct, and appeal denied or rejected claims within strict carrier-allotted windows. Audit weekly accounts receivable aging reports to capture and resolve overdue insurance payments. Patient Relations & Financial Support Act as the dedicated, primary phone and in-person point of contact for patient billing concerns. Explain complex therapy coverage terms, payment expectations, and EOB breakdowns clearly to families. Create itemized patient invoices and establish authorized clinic payment plans for self-pay accounts. Coordinate directly with front-desk staff to streamline regular over-the-counter co-pay collections.

Required Qualifications & SkillsExperience & Education Education :

High school diploma or equivalent; formal medical billing certificate or degree preferred.

Experience :

Preferred minimum of 2 years of active medical billing experience, ideally inside an outpatient physical therapy facility.

Systems :

Advanced operational proficiency utilizing specialized physical therapy EMR software . Specialized Knowledge & Soft Skills Comprehensive structural knowledge of commercial insurance networks, Medicare, Medicaid, and workers' compensation guidelines. Mastery of medical-legal standards, specifically HIPAA compliance laws regarding data security. Exceptional attention to detail to catch coding mismatches and structural data entry errors. Strong, empathetic communication style to navigate difficult financial conversations with patients.

Job Type:

Part-time Pay:

$18.00 - $20.75 per hour

Work Location:

In person