Insurance Verification Specialist

Accountabilities

• • Verify patient insurance eligibility, benefits, and coverage for advanced wound care and cellular tissue products.
  • Conduct detailed benefit investigations with commercial, Medicare, Medicaid, and managed care payers.
  • Determine patient financial responsibility, including deductibles, copayments, coinsurance, and out-of-pocket maximums.
  • Manage eligibility and reimbursement cases while communicating with payer case managers, healthcare providers, sales teams, and field reimbursement personnel.
  • Escalate complex eligibility, coverage, and reimbursement issues to the appropriate stakeholders.
  • Review payer medical policies and coverage criteria applicable to cellular tissue products and wound care therapies.
  • Identify prior authorization, pre-certification, referral, and other payer-specific requirements.
  • Obtain, track, and document authorization requirements and status throughout the reimbursement process.
  • Maintain accurate records of payer communications, verification results, authorization status, and patient account information within CRM or reimbursement management systems.
  • Monitor authorization approvals, denials, and pending requests and conduct timely follow-up to minimize delays in patient treatment.
  • Assist healthcare providers with collecting and submitting clinical documentation required for insurance approvals.
  • Identify payer-specific billing requirements, coding guidelines, and documentation standards relevant to cellular tissue products.
  • Monitor changes to Medicare Local Coverage Determinations (LCDs), commercial payer policies, and reimbursement requirements affecting wound care products.
  • Maintain compliance with HIPAA, CMS regulations, FDA guidelines, internal policies, and applicable healthcare laws.
  • Meet established productivity, quality, and turnaround-time standards for insurance verification and reimbursement activities.
  • Provide professional, responsive, and confidential service to patients, providers, payers, and internal stakeholders.
  • Participate in departmental meetings, training sessions, and in-services as required.

  Requirements

  • At least 5 years of experience in patient access, reimbursement support, medical billing, medical coding, or a closely related healthcare function.
  • Demonstrated expertise in prior authorizations, appeals, benefit investigations, and insurance verification.
  • Strong working knowledge of Medicare, Medicaid, managed care, and commercial payer policies and processes.
  • Experience with medical coding systems, including CPT, HCPCS, and ICD-10-CM, particularly as they relate to wound care and surgical or interdisciplinary services.
  • High school diploma required; an associate or bachelor’s degree in a relevant field is preferred.
  • Experience in wound care or related therapeutic areas, such as advanced wound dressings, skin substitutes, or biologics, is preferred.
  • Experience using case management, reimbursement, or CRM platforms, including Salesforce Health Cloud or similar systems, is advantageous.
  • Background supporting medical devices or healthcare services in hospital or physician office environments is preferred.
  • Strong written and verbal communication skills, with the ability to communicate clearly with providers, payers, and internal teams.
  • Excellent attention to detail and documentation skills, particularly when handling complex insurance and authorization information.
  • Strong organizational and follow-up abilities, with the capacity to manage multiple cases and deadlines simultaneously.
  • Demonstrated personal accountability and commitment to improving patient access and customer outcomes.
  • Ability to maintain strict confidentiality and handle sensitive patient information in accordance with HIPAA and applicable privacy requirements.
  • Strong understanding of healthcare compliance and the ability to adapt to changing payer policies and reimbursement requirements.

  Benefits

  • Permanent, full-time employment opportunity.
  • Remote work arrangement within the United States.
  • Opportunity to directly support patient access to advanced wound care and cellular tissue therapies.
  • Collaborative environment involving healthcare providers, payer representatives, reimbursement specialists, sales teams, and other stakeholders.
  • Opportunity to develop expertise across patient access, reimbursement, insurance verification, and healthcare market access.
  • Exposure to Medicare, Medicaid, commercial payer policies, medical coding, and evolving reimbursement requirements.
  • Opportunity to contribute to process quality, timely treatment access, and improved patient and provider experiences.