Wound Care Insurance Verification Specialist

Role Overview

• Submit and manage prior authorization requests for wound care treatments
• Handle PCP referrals/authorizations and follow up for smooth patient care
• Prepare and track Single Case Agreements/GAP exceptions
• Communicate with insurance providers to clarify coverage and resolve denials
• Maintain precise records of authorizations, denials, appeals, and documentation
• Stay updated with insurance policies and coding changes
• Collaborate with healthcare providers to gather documentation
• Advocate for patients regarding their authorizations and expenses
• Conduct work with discretion, diplomacy, and tact

Requirements

• 1 year of experience in prior authorization management, specifically within wound care services
• Strong work ethic and self-motivation
• Clear and empathetic communication with patients, staff, and payers
• Understanding of insurance processes, medical terminology, and healthcare systems
• Proficiency with electronic medical records (EMR) and case management software
• Ability to collaborate with multidisciplinary healthcare teams and solve complex problems
• Embody NIVA Health’s Core Values in every interaction.