Provider Verification Specialist - Healthcare

Company Summary:

Our client is a commercial leader in regenerative medicine, focused in the areas of bio-active wound healing and soft tissue regeneration.  They are growing quickly and looking to fill this vital role.  Currently, they have approximately 300+ employees in the US and offer an amazing benefit package.

Position Summary:

The Provider Verification Specialist - Patient Care Coordinator will provide billing and reimbursement support to sales specialists, customers, insurers and CMS.  This position will be responsible for receiving and coordinating prior approvals, verifications and processing reimbursements.

Essential Duties and Responsibilities:

·             Investigate patient’s medical benefits and identify opportunities for prior authorizations.

·             Prepare and submit prior authorizations in a timely manner.

·             Effectively interface with hospitals, wound care centers and physicians to insure the highest level of reimbursement is attained.

·             Communicate and accurately document payor trends.

·             Foster partnerships with national accounts.

·             Monitor and update Medicare, Medicaid and Private Payor policies and guidelines.

·             Monitor and communicate policy developments that impact the reimbursement success of products.

·             Help build relationships in key markets with government, physician, hospital, and third-party payer decision makers.

·             Oral presentation skills preferred to give quarterly meetings.

·             Other duties, as needed.

·             High School Diploma Required; preferred, but not required - BA/BS degree in Health care Administration, Business, Economics preferred.

·             3+ years’ of work experience in the health care industry.

·             Must have experience and solid knowledge of medical billing codes (ICD-10)

·             Medical device or biologics experience preferred.

·             Functional expertise in reimbursement and health care policy is necessary.

·             Must possess an intimate knowledge of Medicare, Medicaid, Managed Care and Private Payor reimbursement process.

MUST BE LEGALLY AUTHORIZED TO WORK IN THE US FOR ANY EMPLOYER

Our client provides a comprehensive employee benefits package including Medical, Dental, FSA, STD, LTD, 401K and other terrific benefits.