Wound Care Insurance Verification/Authorization Specialist
InfuSystem is a growing healthcare company that provides infusion pumps and related products and services for patients in hospitals, clinics, ambulatory surgery centers, and other sites of care from five locations serving all 50 states and Canada. We deliver improved patient outcomes and high patient satisfaction.
As a leader in our field, our mission is to provide quality infusion services to patients and medical practices, including a 24-hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of our patients and the communities we serve. Service is always our highest priority.
SUMMARY:
The Wound Care Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information. Has the ability to interpret benefit information and is familiar with insurance terminology to identify and document the correct plan. Request authorizations on payer websites, through fax submissions or over the phone. Responsible for follow-up, documentation, and re-authorizations as necessary.
IN THIS ROLE, THE IDEAL CANDIDATE WILL:
Review and verify patient insurance and confirm patient's eligibility and benefits specific to Advanced Wound Care and Negative Pressure Wound Therapy
Use Medicare portal to verify patient's hospital or skilled nursing status
Initiating, following up, and securing authorizations on from third party payors based on payer requirements for a variety of wound care related HCPCS codes
Track and follow up on all pending authorizations within the timeframe designated by management to expedite the claims process.
Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patients
Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in place
Work closely with NPWT Customer Care team to ensure supporting documentation is received to obtain authorizations timely
Verify authorization quantities and effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems
Organize work to avoid lost revenue due to filing limitations
Input the correct Payer Plan ID# and enter data into appropriate systems to ensure accurate billing for current and future services
Determine the extent of liability for insurance plans, coordination of benefits, and patient financial responsibility. Interact with third-party insurance companies to secure retroactive authorizations, and/or single case agreements for out of network patients, where applicable
Other duties as assigned
SUPERVISORY RESPONSIBILITIES:
There are no supervisory responsibilities
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:
Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.
Familiar with insurance payers and medical benefits
Minimum of two years' experience in a healthcare setting
Organizational skills
Medical terminology
Good troubleshooting skills
Ability to work as a team
Ability to independently meet tight deadlines in a project-based atmosphere
Follows department processes and procedures
Highly motivated and detail-oriented
PERSONAL AND PROFESSIONAL ATTRIBUTES:
The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:
Strong work ethic
Sound judgment
Proven written and verbal communication skills
Natural curiosity to pursue issues and increase expertise
Pursue and design innovative analytical performance metrics
The courage to promote and defend ideas and analyses
Passionate about InfuSystem and serving customers and patients
Strives to make an impact on improving our business processes and results
Exemplary honesty and integrity
Ability to collaborate effectively and work selflessly as part of a team
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPREHENSIVE BENEFIT PACKAGE:
At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!
Health plan options that include an employer contribution
Health Savings Account (HSA)
Healthcare and Dependent Care Flexible Spending Accounts (FSA)
Dental and Vision premiums covered by InfuSystem
Life Insurance, STD & LTD
Paid Parental Leave
Adoption and Fertility Assistance
401(k) with a specified Company Match
Employee Stock Purchase Program
Tuition Assistance
Generous Paid Time Off plan
Employee Assistance Program
Competitive Pay
Employee Referral Bonus
Apply Now
As a leader in our field, our mission is to provide quality infusion services to patients and medical practices, including a 24-hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of our patients and the communities we serve. Service is always our highest priority.
SUMMARY:
The Wound Care Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information. Has the ability to interpret benefit information and is familiar with insurance terminology to identify and document the correct plan. Request authorizations on payer websites, through fax submissions or over the phone. Responsible for follow-up, documentation, and re-authorizations as necessary.
IN THIS ROLE, THE IDEAL CANDIDATE WILL:
Review and verify patient insurance and confirm patient's eligibility and benefits specific to Advanced Wound Care and Negative Pressure Wound Therapy
Use Medicare portal to verify patient's hospital or skilled nursing status
Initiating, following up, and securing authorizations on from third party payors based on payer requirements for a variety of wound care related HCPCS codes
Track and follow up on all pending authorizations within the timeframe designated by management to expedite the claims process.
Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patients
Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in place
Work closely with NPWT Customer Care team to ensure supporting documentation is received to obtain authorizations timely
Verify authorization quantities and effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems
Organize work to avoid lost revenue due to filing limitations
Input the correct Payer Plan ID# and enter data into appropriate systems to ensure accurate billing for current and future services
Determine the extent of liability for insurance plans, coordination of benefits, and patient financial responsibility. Interact with third-party insurance companies to secure retroactive authorizations, and/or single case agreements for out of network patients, where applicable
Other duties as assigned
SUPERVISORY RESPONSIBILITIES:
There are no supervisory responsibilities
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:
Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.
Familiar with insurance payers and medical benefits
Minimum of two years' experience in a healthcare setting
Organizational skills
Medical terminology
Good troubleshooting skills
Ability to work as a team
Ability to independently meet tight deadlines in a project-based atmosphere
Follows department processes and procedures
Highly motivated and detail-oriented
PERSONAL AND PROFESSIONAL ATTRIBUTES:
The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:
Strong work ethic
Sound judgment
Proven written and verbal communication skills
Natural curiosity to pursue issues and increase expertise
Pursue and design innovative analytical performance metrics
The courage to promote and defend ideas and analyses
Passionate about InfuSystem and serving customers and patients
Strives to make an impact on improving our business processes and results
Exemplary honesty and integrity
Ability to collaborate effectively and work selflessly as part of a team
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPREHENSIVE BENEFIT PACKAGE:
At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!
Health plan options that include an employer contribution
Health Savings Account (HSA)
Healthcare and Dependent Care Flexible Spending Accounts (FSA)
Dental and Vision premiums covered by InfuSystem
Life Insurance, STD & LTD
Paid Parental Leave
Adoption and Fertility Assistance
401(k) with a specified Company Match
Employee Stock Purchase Program
Tuition Assistance
Generous Paid Time Off plan
Employee Assistance Program
Competitive Pay
Employee Referral Bonus
Apply Now