Examiner - in - Charge leading examinations of captive insurance companies within Vermont Department of Financial Regulation. A focus on operations, compliance, and financial reporting for oversight of these companies.
About the role
- Wound Care Verification/Authorization Specialist verifying patient eligibility for health care services at InfuSystem. Collaborating with healthcare providers for necessary authorizations and documentation support in a hybrid work environment.
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
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
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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