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

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