DME Benefit Verification Specialist

Compression Care; Vaughan; Remote; CAD 45,000 - 48,000; Full time

Job summary

A leading provider of Durable Medical Equipment is seeking a Benefit Verification Specialist to join their remote team. This role involves verifying patient insurance benefits, ensuring accurate documentation, and facilitating authorization processes. Ideal candidates will have experience in healthcare insurance verification and strong communication skills.

Benefits

Health, dental, and vision insurance

401(k) with company match

Paid time off and holidays

Opportunities for professional development

Qualifications

• Minimum of 1 year in healthcare insurance verification.
• Familiarity with insurance verification tools such as Availity and CGS.
• Strong verbal and written communication skills.

Responsibilities

• Review patient insurance information for coverage.
• Initiate and manage prior authorization requests.
• Document verification and authorization activities in EMR.

Skills

Attention to detail

Communication

Organization

Adaptability

Education

High school diploma or equivalent

Associate degree or higher in a related field

Tools

EMR systems

Microsoft Office Suite

Job description

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Location : Remote

Job Type : Full-time

Salary Range : $45,000.00 - $48,000.00

About Us :

Compression Care, LLC is a leading national provider of Durable Medical Equipment (DME), committed to delivering high-quality products and exceptional service to our patients. We specialize in compression for lymphedema, wound care, vascular, and mastectomy, ensuring our clients receive the best care and equipment tailored to their needs, no matter where they live.

Position Summary :

We are seeking a detail-oriented and knowledgeable Benefit Verification Specialist to join our team. In this role, you will be responsible for verifying patient insurance benefits related to DME, ensuring accurate documentation, and facilitating the authorization process to guarantee timely patient access to necessary equipment. This position requires meticulous attention to detail, excellent communication skills, and a thorough understanding of insurance protocols to facilitate timely and accurate equipment provision to our patients.

Key Responsibilities :

• Insurance Verification : Review patient insurance information to determine coverage for Compression Garments.
• Benefit Analysis : Verify patient-specific benefits, including coverage details, cost-sharing responsibilities, and provider access options, adhering to program-specific standard operating procedures (SOPs).
• Authorization Coordination : Initiate and manage prior authorization requests, including documentation and follow-up with insurance payers.
• Documentation : Accurately document all verification and authorization activities in the electronic medical record (EMR) system. Azalea and a proprietary system are the two we use most often. Send pre-filled prescription requests to physicians.
• Communication : Collaborate with referral sources, healthcare providers, and internal departments to gather required information for benefit verification and respond with benefit information to patients and referral sources.
• Compliance : Ensure all activities comply with HIPAA regulations and company policies.
• Reporting : Identify and report coverage trends or delays to management.
• Continuous Improvement : Participate in training sessions and stay updated on changes in insurance policies and procedures.

Qualifications :

• Experience : Minimum of 1 year in healthcare insurance verification, with knowledge of DME products and terminology.
• Education : High school diploma or equivalent required; associate degree or higher in a related field preferred.
• Technical Skills : Proficiency in EMR systems and Microsoft Office Suite.
• Knowledge : Familiarity with insurance verification tools such as Availity, CGS, and understanding of various payer requirements. Strong understanding of insurance processes, including Medicare, Medicaid, and commercial payers.
• Communication : Strong verbal and written communication skills.
• Organization : Excellent organizational skills with attention to detail.
• Adaptability : Ability to work in a fast-paced environment and adapt to changing procedures and regulations.

Preferred Qualifications :

• Certified Medical Reimbursement Specialist (CMRS) or Certified Medical Insurance Specialist (CMIS) credentials.
• Prior experience with DME billing and coding.
• Knowledge of HIPAA regulations and patient confidentiality standards.
• Health, dental, and vision insurance
• 401(k) with company match
• Paid time off and holidays
• Opportunities for professional development and career advancement

Application Process :

To apply, please submit your resume and a cover letter detailing your relevant experience and qualifications to [e-mail]

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Benefit Specialist • Vaughan, ON, Canada