Wound Care Insurance Verification/Authorization Specialist (Part Time)

InfuSystem•,

About The Position

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.

Requirements

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
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

Responsibilities

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