Basic Information

Job Category: Administrative/Office

Location: New Berlin, Wisconsin, United States

Date published: 09-Jun-2022

Job type: Full Time

Description and Requirements

About the role

New Berlin, WI

Join us and give people a voice

Health Insurance Verification Specialist

We are a specialized medical device company and the clear market and technology leader for voice and pulmonary rehabilitation for cancer patients who have lost their voice box. We design, manufacture and sell our entire core portfolio directly to leading institutions, health care professionals and patients. We believe everyone should have the right to speak, also after their cancer. That’s why we are committed to giving a voice to people who breathe through a stoma, with design solutions and technologies built on decades of experience and a deep understanding of our users.

We have an immediate opening in the Insurance Department.

The Health Insurance Verification Specialist will support the company's mission to provide a better quality of life for laryngectomy customers by assisting with the attainment of our products through the insurance verification process and reimbursement cycle. A successful Health Insurance Verification Specialist in our company uses client information and insurance management knowledge to perform insurance verifications, authorizations, pre-certifications, and negotiations. The Health Insurance Verification Specialist will analyze and offer advice to our customers regarding insurance matters to ensure a smooth order process workflow. They will also interact and advise our internal team members on schedules, decisions, and potential issues from the Insurance payers.

Job responsibilities for the Health Insurance Verification Specialist
  • Act as an advocate for our customers in relation to insurance benefit verification
  • Obtain and secure authorization, or pre-certifications required for patients to acquire our products
  • Verifies the accuracy and completeness of patient account information
  • Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems
  • Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for customers. Follows up with physician offices, customers and third-party payers to complete the pre-certification process
  • Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical necessity
  • Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations
  • Educates customers, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends
  • Verifies that all products that require prior authorizations are complete. Updates customers and customer support team on status. Assists in coordinating peer to peer if required by insurance payer
  • Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify customer support team if authorization/certification is denied
  • Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans
  • Inquire about gap exception waiver from out of network insurance payers
  • Educate medical case reviewers at Insurance Companies about diagnosis and medical necessity of our products
  • Obtaining single case agreements when requesting an initial authorization with out of network providers. This process may entail the negotiation of pricing and fees and will require knowledge of internal fee schedules, out of network benefits, and claims information
  • Complete all Insurance Escalation requests as assigned and within department guidelines for turn around time
  • Maintains reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans
  • Other duties as assigned by the management team
  • Answer incoming calls from insurance companies and customers and about the insurance verification process using appropriate customer service skills and in a professional, knowledgeable, and courteous manner
  • Participate in surveys conducted by authorized inspection agencies
Health Insurance Verification Specialist

An individual in this position must be able to successfully perform the essential duties and responsibilities listed above. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

The above list reflects the general details necessary to describe the principle and essential functions of the position and shall not be construed as the only duties that may be assigned for the position.

Requirements
Basic Requirements for the Health Insurance Verification Specialist:
  • High School Diploma or G.E.D.
Preferred Qualifications for the Health Insurance Verification Specialist:
  • 2+ years of experience with medical insurance verification background
  • Licenses/Certifications: Medical coding and billing certifications preferred
  • Experience with following software preferred: Salesforce, SAP, Brightree, Adobe Acrobat
  • Knowledge Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans
  • Experience in customer service in a health care related industry
Skills and Competencies for Health Insurance Verification Specialist:
  • Demonstrated proficiency in phone skills (professional attitude, clear intelligible communication)
  • Ability to work independently and set priorities
  • Possess effective interpersonal and communication skills
  • Understanding of basic human anatomy, medical terminology and procedures for application in the insurance verification, pre-certification / authorization processes
  • Ability to read and interpret prescriptions
  • Persuasion and negotiation skills
  • Conflict resolution and problem solving skills
  • Intermediate computer skills including the use of MSO365, MS Word, MS Excel, Email program, and medical records systems are highly recommended
  • Ability to effectively communicate with a variety of people under stressful circumstances
  • Adaptable to change

Benefits
Health Insurance Verification Specialist

We offer:

You will be part of an ambitious work environment in which teams work together to continuously grow and develop the business. You will have great opportunities to learn and develop, and you will be offered a competitive salary package and benefits.

We are a global leader with Swedish headquarters and more than 15 subsidiaries worldwide. We are committed to living our values: we listen – we inspire – we focus – we engage every day. We connect with stakeholders, involving them in our activities and striving to support and empower our users and each other every day. No matter whom we interact with – users, colleagues, health care professionals, business partners – respect and integrity are at the core of everything we do.

We are an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Additional benefits for Health Insurance Verification Specialist:
  • Competitive Pay
  • Health Care Plan (Medical, Dental & Vision)
  • Retirement Plan (401k)
  • Life Insurance
  • Paid Time Off (Vacation, Sick & Public Holidays)
  • Training & Development
  • Wellness Resources
  • State of the Art Facility
  • Gourmet Coffee