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. Hybrid or Remote. Please note, that if not within a commutable distance to Rochester Hills, MI the option to work remotely will be considered.

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

Skills

• Electronic Medical Record Systems
• Problem Solving
• Troubleshooting

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.