Wound Care Insurance Verification Specialist

Role Overview

• 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.