Wound Care Insurance Approval Coordinator

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 (SCAs)/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 in Athena EHR
• Stay up to date with insurance policies, coding changes, and criteria for wound care procedures
• Collaborate with 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
• Have direct experience with PCP referrals/authorizations, GAP exceptions, and Single Case Agreements
• Are proficient with Athena EHR (required)
• 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
• Excel at collaborating with multidisciplinary healthcare teams and solving complex problems
• Embody NIVA Health’s Core Values in every interaction with patients and colleagues