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Role Description

Do you have a meticulous eye for detail and a passion for helping patients access the care they need? Are you experienced in navigating insurance guidelines, prior authorizations, and the specialized world of wound care? If so, NIVA Health invites you to apply for our Remote Insurance Verification Specialist position!

As a key member of our authorization coordination team, you will play a pivotal role in ensuring patients receive timely, necessary treatment, all while exemplifying our Core Values of Teamwork, Resilience, Open-Mindedness, Ownership, and Positivity.

• 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.

Qualifications

• 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.

Requirements

• Bonus Points If You:
• Are experienced in handling appeals, denials, and single case agreements.
• Bring innovative approaches to patient advocacy and insurance coordination.
• Stay informed about industry trends, especially in advanced wound care and insurance policy changes.

Benefits

At NIVA Health, your efforts are instrumental in ensuring that patients receive the life-changing care they deserve. We celebrate our team’s achievements, invest in personal and professional growth, and provide meaningful work in a values-driven, supportive environment. Join us and help shape a brighter, healthier future for all—one successful authorization at a time!

Company Description

• Pay: $1,300 per month (Up to R20,553.78 per month)
• Work Schedule: US Timezone (East Coast)
• Job Type: Full-time
• Work Location: Remote