Insurance Verification Specialist

Insurance Verification Specialist

Incubator New Businesses

Location remote – N/A

Permanent  

Full Time

 

 

About Heraeus

Solutions from the Heraeus Group provide faster internet, rid water of germs, and keep hearts beating in time. As a broadly diversified and globally leading family-owned technology company, we combine materials expertise and technological leadership to create the most diverse products, all with one thing in common: World-class quality. Working with customers around the world, we shape the future and provide vital innovations in the areas of Metals & Recycling, Healthcare, Semiconductor & Electronics and Industrials. Heraeus is one of the top 10 family-owned companies in Germany and has a team of around 17,200 employees in 40 countries.

About Engineered Tissue Solutions

Engineered Tissue Solutions was acquired in 2021 by the Heraeus Group, a broadly diversified family-owned technology company. Learn more about Heraeus Group at www.heraeus.com.

The following challenges await you:

• 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 all 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 all patient and provider interactions.
• Attend departmental meetings and in-services as requested

Your Profile:

• Takes personal accountability for supporting customers and improving patient access to ETS products.
• 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; Bachelor's or Associate’s degree preferred

Preferred Qualifications

• Experience with wound care or related therapeutic areas (e.g., advanced wound dressings, skin substitutes, biologics.)
• Experience with case management platforms (e.g., Salesforce Health Cloud, custom CRM systems)
• Background in medical device in the hospital or physician office setting