NIVA Health is hiring a Wound Care Insurance Verification Specialist to join our authorization coordination team. In this remote role, you will manage prior authorizations and insurance processes for wound care treatments, ensuring patients receive timely and necessary care. Your work will directly support our mission of helping people heal.

What You'll Do

Submit and manage prior authorization requests for wound care treatments, ensuring all documentation meets payer requirements.
Handle PCP referrals and authorizations, following up to facilitate smooth 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 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 and accurate documentation for submissions.
Serve as a patient advocate, keeping patients informed about authorization status and potential out-of-pocket expenses.
Conduct 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.

What We're Looking For

At least 1 year of experience in prior authorization management, specifically within wound care services.
Strong work ethic, self-motivation, and a 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.
Embodies NIVA Health's Core Values: Teamwork, Resilience, Open-Mindedness, Ownership, and Positivity.

Nice to Have

Experience in handling appeals, denials, and single case agreements.
Brings innovative approaches to patient advocacy and insurance coordination.
Stays informed about industry trends, especially in advanced wound care and insurance policy changes.