Insurance Verification Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔒 Insurance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Heraeus

WebsiteLinkedInAll Job Openings

10,000+ employees

🏭 Manufacturing

🏥 Healthcare

Manufacturing • Healthcare

Heraeus is a broadly diversified and globally leading family-owned technology company, headquartered in Hanau, Germany. The company specializes in precious metals, materials and technologies, biomaterials and medical products, sensors, quartz glass, specialty lighting sources, and chemicals. With deep roots dating back to a family pharmacy established in 1660, Heraeus now operates across various sectors, including environmental, electronics, health, and industrial applications, providing innovative technologies and solutions to customers worldwide.

📋 Description

• Verify patient insurance eligibility, benefits, and coverage for advanced wound care and cellular tissue products • Conduct 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 cases and communicate with payer case managers, customer providers, sales, and field reimbursement personnel to facilitate patient access to therapy • Escalate complex eligibility or coverage issues when appropriate • Review payer medical policies and coverage criteria specific to cellular tissue products and wound care therapies • Obtain and document prior authorization requirements, pre-certifications, and referral requirements • Maintain accurate documentation of payer communications, verification details, authorization status, and patient account notes within the CRM or reimbursement management system • Monitor authorization approvals, denials, and pending requests while ensuring timely follow-up to prevent delays in patient treatment • Assist providers with gathering and submitting supporting clinical documentation required for insurance approvals • Identify payer-specific billing requirements, coding guidelines, and documentation standards for cellular tissue products • Stay current on Medicare Local Coverage Determinations (LCDs), commercial payer policies, and reimbursement policy changes impacting wound care products • Maintain compliance with HIPAA, CMS regulations, FDA guidelines, company policies, and applicable healthcare laws • Maintain productivity, quality, and turnaround time standards for insurance verification activities to ensure timely patient care • Provide exceptional customer service while maintaining professionalism and confidentiality in patient and provider interactions • Attend departmental meetings and in-services as requested

🎯 Requirements

• Minimum 5 years of experience in patient access, reimbursement support, or medical billing/coding • Demonstrated expertise in prior authorizations, appeals, and benefit investigations • Strong working knowledge of Medicare, Medicaid, and commercial payer policies and processes • Experience with medical coding systems (CPT, HCPCS, ICD-10-CM) relevant to wound care and surgical interdisciplinary • Excellent written and verbal communication skills • High School Diploma Required • Experience with wound care or related therapeutic areas preferred • Experience with case management platforms (e.g., Salesforce Health Cloud, custom CRM systems) preferred • Background in medical device in the hospital or physician office setting preferred