Wound Care Insurance Verification/Authorization Specialist
About the position
InfuSystem is a leading national health care service provider, facilitating
outpatient care for durable medical equipment manufacturers and health care
providers by delivering ambulatory pumps and supplies, along with related
clinical, biomedical and billing services, to practices and patients nationwide.
With a comprehensive suite of services, InfuSystem improves clinician access to
quality medical equipment and promotes patient wellness and safety while
reducing the overall cost of infusion care.
InfuSystem offers Oncology, Pain Management and Wound Care therapies, including
Negative Pressure Wound Therapy. The company’s Durable Medical Equipment (DME)
Services are composed of direct payer rentals, pump and consumable sales, and
biomedical services and repair, including on-site and depot services. InfuSystem
provides the sale, rental, lease and associated supplies, including infusion
pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain
pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps,
enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump
tubing, ambulatory pumps, replacement pumps, disposable products, central venous
access devices, closed system transfer devices, negative pressure wound therapy
vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical
services include both on-site and depot preventive maintenance, repair and
warranty services, ranging from equipment inspections to extensive repairs,
including compression device systems, defibrillators, EKG machines,
electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs,
light sources, modules, patient monitors, printers, pulse oximeters, telemetry
transmitters and tourniquets – all completed to factory specifications.
Headquartered in Rochester Hills, Michigan, InfuSystem delivers local,
field-based customer support and operates Centers of Excellence in Michigan,
Kansas, California, Massachusetts, Texas and Ontario, Canada.
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. Remote versus hybrid setting
will be determined upon review of residence. Required hours are 9:30 am - 6:30
pm Eastern Time.
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
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
Benefits
• 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
InfuSystem is a leading national health care service provider, facilitating
outpatient care for durable medical equipment manufacturers and health care
providers by delivering ambulatory pumps and supplies, along with related
clinical, biomedical and billing services, to practices and patients nationwide.
With a comprehensive suite of services, InfuSystem improves clinician access to
quality medical equipment and promotes patient wellness and safety while
reducing the overall cost of infusion care.
InfuSystem offers Oncology, Pain Management and Wound Care therapies, including
Negative Pressure Wound Therapy. The company’s Durable Medical Equipment (DME)
Services are composed of direct payer rentals, pump and consumable sales, and
biomedical services and repair, including on-site and depot services. InfuSystem
provides the sale, rental, lease and associated supplies, including infusion
pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain
pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps,
enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump
tubing, ambulatory pumps, replacement pumps, disposable products, central venous
access devices, closed system transfer devices, negative pressure wound therapy
vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical
services include both on-site and depot preventive maintenance, repair and
warranty services, ranging from equipment inspections to extensive repairs,
including compression device systems, defibrillators, EKG machines,
electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs,
light sources, modules, patient monitors, printers, pulse oximeters, telemetry
transmitters and tourniquets – all completed to factory specifications.
Headquartered in Rochester Hills, Michigan, InfuSystem delivers local,
field-based customer support and operates Centers of Excellence in Michigan,
Kansas, California, Massachusetts, Texas and Ontario, Canada.
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. Remote versus hybrid setting
will be determined upon review of residence. Required hours are 9:30 am - 6:30
pm Eastern Time.
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
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
Benefits
• 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