Rehabilitation- Insurance Verification & Referral Coordinator

Description

Job Description : Rehabilitation- Insurance Verification and Referral Coordinator

FLSA Status: Non-Exempt

Supervision Received: Rehabilitation Front Office Supervisor

Supervision Exercised : None

Position Summary

The Insurance Verification and Referral Coordinator is responsible for ensuring timely verification of insurance benefits for outpatient physical and occupational therapy services. This dual function role supports the rehabilitation department by appropriately managing referrals, scheduling patients according to departmental policies and procedures.

Duties and Responsibilities

- Verify patient insurance coverage and therapy-specific benefits prior to treatment

- Determine authorization requirements and obtain prior authorization as needed

- Communicate coverage details and out-of-pocket expectations to front office staff and clinicians

- Prepare and submit accurate electronic and paper claims using appropriate CPT, ICD-10, and modifier codes

- Ensure claims are submitted in accordance with payer-specific rules and deadlines

- Track claim status and identify issues early in the billing cycle

- Research and resolve denied or rejected claims

- Submit appeals or corrected claims as needed

- Coordinate with therapists for documentation needed to support medical necessity

- Accurately post insurance and patient payments

- Review EOBs/ERAs and reconcile discrepancies

- Follow up on outstanding claims and aging accounts

- Maintain clear records of all verification and billing activity

- Communicate proactively with therapists, front desk staff, and patients regarding billing issues

- Assist with maintaining and updating payer requirements reference materials

Qualifications

- 1-2 years of experience in medical billing or insurance verification, ideally in a therapy or outpatient setting

Preferred Qualifications

- High school diploma or equivalent required; medical billing certification or associate’s degree preferred.

Core Competencies

- Strong leadership, communication, and interpersonal skills

- Skilled in coaching, staff development, and performance management

- Ability to manage competing priorities, meet deadlines, and drive process improvements

- Discretion in handling confidential personnel and legal matters

- Adaptability to changing regulations and organizational needs

Physical Requirements

- Requires sitting and standing associated with a typical office environment. Some bending and stretching are required.

- Manual dexterity using a calculator and computer keyboard.

Work Environment

Normal office environment