Funding Verification Specialist - Remote

Lingraphica•West Windsor, NJ

8d•$50,000 - $55,000•Remote

About The Position

The Funding Verification Specialist is responsible for verifying insurance benefits, determining appropriate funding and payment options, and assessing case/deal viability to support successful device trials and procurement so that appropriate candidates may trial and procure a Lingraphica device.

Requirements

Knowledge of insurance plans, funding sources, and reimbursement processes related to Durable Medical Equipment (DME).
Strong data entry, documentation, and organizational skills with a high level of accuracy and attention to detail.
Methodical approach to gathering information, conducting research, and resolving issues effectively.
Effective verbal and written communication skills with a professional, customer-focused approach.
Compassion for individuals with disabilities and the ability to communicate effectively with clients who have speech impairments.
Ability to build rapport and maintain professionalism when interacting with clients, caregivers, providers, and internal stakeholders.
Strong critical thinking and problem-solving skills, with the ability to assess risk and make informed decisions.
Ability to exercise sound independent judgment within established guidelines and appropriately escalate complex or high-risk situations.
Ability to identify alternative solutions, evaluate options, and recommend appropriate courses of action.
Demonstrates adaptability in response to changing priorities, processes, and business needs.
Exhibits innovative thinking and a willingness to explore new approaches to improve outcomes and efficiency.
Open to giving and receiving feedback, with a commitment to continuous learning and professional growth.
Ability to manage multiple priorities and maintain consistent performance in a fast-paced, process-driven environment.
Strong attention to detail while balancing productivity, quality, and timeliness.
Maintains a sense of urgency and takes ownership of responsibilities through to resolution.
Proactive, solutions-oriented mindset with the ability to anticipate challenges and address them effectively.
Demonstrates accountability, follow-through, and ownership of assigned work.
Takes initiative to identify opportunities for improvement and contribute to team and organizational success.
High School Diploma or GED, required
3 years of healthcare, insurance, DME, medical billing, benefits verification, or related experience, required
Experience with Medicare, Medicaid and Commercial insurance, required

Nice To Haves

Associate's degree or equivalent combination of education and experience, preferred
Experience in customer service and/or administrative support, preferred
Experience with Microsoft Office, TrueSight, Inovalon, or HubSpot, preferred

Responsibilities

Acquire insurance benefit coverage via phone or online portal
Interpret benefit coverage information to determine anticipated costs for clients
Use discernment and judgment to evaluate the accuracy, completeness, and reliability of insurance benefit information and identify discrepancies or gaps requiring additional verification
Assess case viability by evaluating expected reimbursement, payor requirements, funding criteria, and the likelihood of successful reimbursement prior to initiating a trial.
Determine device trial funding options based on the patient’s insurance coverage
Recognize and identify potential coordination of benefits (COB) issues and proactively engage with the patient and/or care partner to gather information and assist in resolving discrepancies.
Review benefits for accuracy prior to sale
Clearly communicate funding determinations, potential barriers, and recommended next steps clearly to internal teams and, when appropriate, patients and care partners.
Maintain accurate, complete, and compliant documentation of insurance verification, funding determinations, patient records, and related communications in accordance with HIPAA, Medicare, and organizational requirements.
Proactively communicate with team members regarding identified potential issues and concerns
Maintain patient records according to HIPAA and Medicare guidelines
Track and trend issues to aid in the resolution and prevention of repeat problems
Complete all administrative functions, such as data entry, associated with sales activities in a timely manner and in accordance with established processes
Identify and escalate priority issues and proactively follow up on tasks
Perform other duties and special projects as assigned