Wound Care Insurance VerificationAuthorization Specialist

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 companys 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.

IN THIS ROLE THE IDEAL CANDIDATE WILL:

• Review and verify patient insurance and confirm patients eligibility and benefits specific to Advanced Wound Care and Negative Pressure Wound Therapy
• Use Medicare portal to verify patients 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 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

Required Experience:

IC