Insurance Verification Specialist
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Job Description
Wound Care Insurance Verification Specialist managing authorization requests for wound care treatments at NIVA Health. Collaborating with healthcare teams and insurance providers to ensure patients receive necessary care.
Responsibilities:
- Submit and manage prior authorization requests for wound care treatments, ensuring that all documentation meets payer requirements.
- Handle PCP referrals/authorizations and follow up to facilitate smooth patient care.
- Prepare and track Single Case Agreements/GAP exceptions for out-of-network cases.
- Communicate with insurance providers to clarify coverage, resolve denials, and facilitate appeals.
- Maintain precise records of authorizations, denials, appeals, and corresponding documentation.
- Stay up to date with insurance policies, coding changes, and criteria for wound care procedures.
- Collaborate with healthcare providers, nurses, and admin staff to gather complete, accurate documentation for submissions.
- Serve as a patient advocate, keeping patients informed about the status of their authorizations and potential out-of-pocket expenses.
- Conduct your work with utmost discretion, diplomacy, and tact during all patient and staff interactions.
- Contribute to other duties of similar complexity as assigned by your supervisor.
Requirements:
- Possess at least 1 year of experience in prior authorization management, **specifically within wound care services**.
- Demonstrate a strong work ethic, self-motivation, and a “can-do” attitude.
- Communicate clearly, empathetically, and professionally with patients, staff, and payers.
- Understand the intricacies of insurance processes, medical terminology, and healthcare systems.
- Are proficient with electronic medical records (EMR) and case management software.
- Excel at collaborating with multidisciplinary healthcare teams and solving complex problems.
- Embody NIVA Health’s Core Values in every interaction with patients and colleagues.
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