Wound Care Insurance Verification Specialist (Remote)

2 hours, 28 minutes ago
Full-time
Junior
Customer and Technical Support
NIVA Health

NIVA Health

NIVA Health offers innovative therapies to heal chronic pain and injuries, focusing on holistic and natural treatments to avoid surgeries and medications.

Health Care Providers & Services
11-50

Description

  • Submit and manage prior authorization requests for wound care treatments and ensure documentation meets payer requirements.
  • Handle PCP referrals and authorizations, including follow-up to support patient care.
  • Prepare and track Single Case Agreements and GAP exceptions for out-of-network cases.
  • Communicate with insurance providers to clarify coverage, resolve denials, and support appeals.
  • Maintain accurate records of authorizations, denials, appeals, and related documentation.
  • Stay current on insurance policies, coding changes, and wound care coverage criteria.
  • Collaborate with providers, nurses, and administrative staff to gather complete submission documentation.
  • Serve as a patient advocate by keeping patients informed about authorization status and out-of-pocket costs.
  • Use discretion, diplomacy, and tact in interactions with patients and staff.
  • Perform other duties of similar complexity as assigned by the supervisor.

Requirements

  • At least 1 year of experience in prior authorization management, specifically within wound care services.
  • Strong work ethic, self-motivation, and a positive, can-do attitude.
  • Clear, empathetic, and professional 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.
  • Experience handling appeals, denials, and single case agreements is preferred.
  • Interest in staying informed about advanced wound care and insurance policy changes is preferred.

Benefits

  • Remote full-time position.
  • Work schedule in US East Coast time zone.
  • Monthly pay of $1,300 (up to R20,553.78 per month).
  • Meaningful work supporting patient access to care.
  • Supportive, values-driven work environment.
  • Opportunities for personal and professional growth.

Interested in this position?

Apply directly on the company website

Apply Now

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