Insurance Verification Specialist
NIVA Health
full-time
Posted on:
Location Type: Remote
Location: South Africa
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Salary
💰 $1,300 per month
Job Level
About the role
- Submit and manage prior authorization requests for wound care treatments, ensuring that all documentation meets payer requirements.
- Handle PCP referrals/authorizations and follow up to facilitate smooth patient care.
- Prepare and track Single Case Agreements/GAP exceptions for out-of-network cases.
- Communicate with insurance providers to clarify coverage, resolve denials, and facilitate appeals.
- Maintain precise records of authorizations, denials, appeals, and corresponding documentation.
- Stay up to date with insurance policies, coding changes, and criteria for wound care procedures.
- Collaborate with healthcare providers, nurses, and admin staff to gather complete, accurate documentation for submissions.
- Serve as a patient advocate, keeping patients informed about the status of their authorizations and potential out-of-pocket expenses.
- Conduct your work with utmost discretion, diplomacy, and tact during all patient and staff interactions.
- Contribute to other duties of similar complexity as assigned by your supervisor.
Requirements
- Possess at least 1 year of experience in prior authorization management, **specifically within wound care services**.
- Demonstrate a strong work ethic, self-motivation, and a “can-do” attitude.
- Communicate clearly, empathetically, and professionally with patients, staff, and payers.
- Understand the intricacies of insurance processes, medical terminology, and healthcare systems.
- Are proficient with electronic medical records (EMR) and case management software.
- Excel at collaborating with multidisciplinary healthcare teams and solving complex problems.
- Embody NIVA Health’s Core Values in every interaction with patients and colleagues.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
prior authorization managementwound care servicesmedical terminologyinsurance processesdocumentation managementappeals processingSingle Case AgreementsGAP exceptionscoding changespatient advocacy
Soft Skills
strong work ethicself-motivationcan-do attitudeclear communicationempathyprofessionalismcollaborationproblem-solvingdiscretiondiplomacy