Preauthorization Specialist
Full Time • OPTI-Coeur d'Alene
Benefits:
- 401(k)
- Competitive salary
- Dental insurance
- Health insurance
- Paid time off
- Profit sharing
- Vision insurance
The Physical Therapy Prior Authorization Specialist is responsible for obtaining insurance authorizations for outpatient physical and occupational therapy services. This role ensures timely submission, tracking, and follow-up of authorization requests to prevent delays in patient care and reimbursement. The specialist works closely with providers, clinical staff, billing, and insurance payers to support compliance and revenue cycle integrity. Performs other related duties as assigned.
Essential Job Functions:
- Verify insurance benefits for physical therapy services.
- Determine prior authorization requirements for commercial, Medicare Advantage, Medicaid, and workers’ compensation plans.
- Submit prior authorization requests with required clinical documentation.
- Track and monitor authorization status to ensure approval before services are rendered.
- Follow up with insurance carriers for pending, denied, or partially approved requests.
- Communicate authorization determinations to scheduling, therapy staff, and billing teams.
- Review and appeal authorization denials when appropriate.
- Ensure authorizations reflect accurate CPT codes, ICD-10 diagnoses, frequency, and duration of therapy.
- Maintain detailed documentation of all payer communications.
- Monitor authorization expiration dates and request extensions as needed.
- Stay current on payer-specific guidelines and policy updates.
- Maintain HIPAA compliance and protect patient confidentiality.
Knowledge and Skills
Strong understanding of:
Strong understanding of:
- CPT and ICD-10 coding related to physical and occupational therapy
- Medical necessity documentation standards
- Commercial and Medicare Advantage prior authorization processes
- Familiarity with major payers such as:
Blue Cross of Idaho
UnitedHealthcare
Aetna
Blue Cross Blue Shield
Cigna
UnitedHealthcare
Aetna
Blue Cross Blue Shield
Cigna
- Knowledge of utilization management and therapy visit limits.
- Strong attention to detail and organizational skills.
- Ability to manage high-volume workflows with strict deadlines.
- Effective written and verbal communication skills.
- Proficiency with EMR and payer portals.
Minimum Qualifications:
1. High school diploma or equivalent.
2. Excellent communication and interpersonal skills.
3. 1-3 years of medical insurance authorization or medical billing preferred.sla
4. Orthopedic or physical therapy practice experience preferred.
5. Efficient in the use of standard office equipment, data entry, typing, 10-key skills, and alpha/numerical filing.
Essential Functions (Physical):
1. High school diploma or equivalent.
2. Excellent communication and interpersonal skills.
3. 1-3 years of medical insurance authorization or medical billing preferred.sla
4. Orthopedic or physical therapy practice experience preferred.
5. Efficient in the use of standard office equipment, data entry, typing, 10-key skills, and alpha/numerical filing.
Essential Functions (Physical):
- Regular and predictable attendance is an essential job function.
- Majority of the shift is spent sitting.
- Frequent reaching, stooping and twisting when filing, accessing records and answering telephone
- Ability to lift up to 25 pounds.
- Read a variety of printed and handwritten materials, computerized reports, manuals, and correspondence.
- Communicates with patients, physicians, families and co-workers in person and on the telephone.
- Comply with company policies, procedures, practices and business ethics guidelines.
- Complete job required training.
- Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
- Work in the office during business hours
- Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines
- Communicate and interact in a respectful and professional manner
- Prioritize workload while being flexible to meet the expectations of the daily operations
- Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions
- Understand and execute a variety of instructions
- Work independently with minimal supervision
Work Environment:
- Our physical therapy department operates in a professional office environment. Days and hours of work for this position are conducted Monday thru Friday 8:00 am to 5:00 pm.
- This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
- Orthopedic Surgery & Sports Medicine has multiple locations and travel may be required.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Compensation: $19.00 - $24.00 per hour
Orthopedic Surgery and Sports Medicine provides the highest quality comprehensive orthopedic experience for patients in the Inland Northwest. We are owned and operated by board certified and fellowship trained orthopedic surgeons. In addition, we also offer Orthopedic Physical and Occupational Therapy, as well as providing patient access to our same day walk in clinic for acute orthopedic or occupational injuries. We have a total of 4 locations between Coeur d’Alene, Post Falls, and Hayden Idaho.
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