Provider Benefit Verification Specialist II

Role Summary

The Provider Benefit Verification Specialist II supports billing and reimbursement efforts for sales specialists and customers. This role interfaces with hospitals, wound care centers, and physicians to optimize reimbursement outcomes, monitors payer policies, and ensures accurate documentation of payer trends. Training is on-site with a transition to a mix of in-office and remote work as required.

Responsibilities

• Investigate patient’s medical benefits and identify opportunities for prior authorizations.
• Prepare and submit prior authorizations in a timely manner.
• Interface with hospitals, wound care centers and physicians to ensure the highest level of reimbursement.
• Communicate and accurately document payer trends.
• Foster partnerships with national accounts.
• Monitor and update Medicare, Medicaid and private payer policies and guidelines.
• Monitor and communicate policy developments that impact reimbursement success.
• Build relationships in key markets with government, physician, hospital, and third-party payer decision makers.
• Demonstrate understanding of payer policies and leverage this knowledge to support the benefit verification process.
• Utilize reimbursement tools to minimize customer inquiries.
• Meet strict metrics for quota and turn-around time.
• Complete 16-22 reimbursement cases consistently.
• Comply with all company policies and procedures.
• Perform other duties as needed.

Qualifications

• Required: High school diploma or equivalent; 3+ years’ experience in Healthcare reimbursement; 1+ year of Prior Authorization experience; functional expertise in reimbursement and healthcare policy with knowledge of Medicare, Medicaid, managed care and private payer processes; ability to communicate professionally with providers, insurers, and internal teams.
• Preferred: BA/BS degree in Healthcare Administration, Business, or Economics; medical device or biologics experience.

Skills

• Polished and professional presence and phone manner.
• Excellent customer service skills.

Education

• High school diploma or equivalent required; BA/BS preferred.

Additional Requirements

• Physical Activities: Remaining in a sitting position for long periods; repetitive motions of wrists, hands, and fingers.
• Environmental Conditions: Working indoors; no adverse environmental conditions.