Snapscale is looking for an expert Authorization and Eligibility Medical Billing Specialist to perform the following functions:
- Verify insurance eligibility, benefits, exclusions, deductibles, co-pays, and co-insurance for occupational and speech therapy patients.
- Contact insurance providers to clarify discrepancies or misquoted benefits.
- Enter benefit details into forms and calculate patient responsibility (worst- and best-case coverage scenarios).
- Complete good-faith estimates.
- Check, submit, and track therapy authorization requirements.
- Ensure all services have valid authorizations to prevent denials.
- Upload and process data from E-Bridge Software; maintain accurate and updated EMR records.
- Review medical records to confirm authorization and eligibility accuracy.
- Use medical terminology and coding knowledge for eligibility and authorizations.
- Re-verify insurance coverage based on denial codes.
- Protect patient confidentiality and comply with HIPAA regulations.
- Work with providers and staff to resolve authorization and billing issues.
- Perform follow-up tasks related to billing as directed by the Senior Medical Billing & RCM Manager.
Requirements:
- 5+ years of experience handling insurance authorizations, eligibility, and benefits verification for OT, PT, and SLP clinics (pediatrics preferred)
- Proficient in insurance portals, calling insurers, and EMR data entry
- Ideal candidate has experience with Fusion Web Clinic EMR (Therapy Brands)
- Experienced in billing for OT, PT, and SLP services
- Background in private practice settings preferred
- Strong medical terminology, anatomy, and insurance billing knowledge
- Detail-oriented, hardworking, and diligent
- Tech-savvy and quick to learn new EMR systems
- Accurate in coding and billing with strong understanding of reimbursement processes
- Clear communicator; able to work effectively with providers, insurers, and patients
- Highly reliable and responsive