Wound Care Insurance Verification/Authorization Specialist

Infusystem - Rochester Hills, MI

Full-time - Mid Level

Rochester Hills, MI

Wholesale Trade Agents and Brokers

About the position

The Wound Care Verification/Authorization Specialist at InfuSystem is responsible for verifying patient eligibility and benefit information related to Advanced Wound Care and Negative Pressure Wound Therapy. This role involves interpreting insurance benefits, securing authorizations from third-party payors, and ensuring timely processing of claims to enhance patient outcomes and satisfaction. The specialist will work closely with the NPWT Customer Care team and manage documentation to avoid lost revenue due to filing limitations.

Responsibilities

• Verify patient insurance and confirm eligibility and benefits for Advanced Wound Care and Negative Pressure Wound Therapy.
• Use Medicare portal to verify patient's hospital or skilled nursing status.
• Request authorizations from third-party payors based on payer requirements for various wound care related HCPCS codes.
• Track and follow up on all pending authorizations to expedite the claims process.
• Process authorizations electronically using payer portals, fax, or telephone.
• Obtain authorization renewals and verify physician written orders are active.
• Work with NPWT Customer Care team to ensure supporting documentation is received timely.
• Verify authorization quantities and effective dates are processed correctly by third-party payers.
• Input the correct Payer Plan ID# and enter data into appropriate systems for accurate billing.
• Interact with third-party insurance companies to secure retroactive authorizations.

Requirements

• Associate degree or equivalent; two to four years related experience and/or training.
• Familiarity with insurance payers and medical benefits.
• Minimum of two years' experience in a healthcare setting.
• Strong organizational skills and medical terminology knowledge.
• Good troubleshooting skills and ability to work as a team.
• Ability to independently meet tight deadlines.

Nice-to-haves

• Experience with Electronic Medical Record Systems.
• Problem-solving skills.

Benefits

• Paid parental leave
• Health savings account
• Employee stock purchase plan
• Disability insurance
• Health insurance
• Dental insurance
• Flexible spending account
• Tuition reimbursement
• Paid time off
• Parental leave
• Employee assistance program
• Vision insurance
• 401(k) matching
• Life insurance
• Referral program