Insurance Verification Specialist

Engineered Tissue Solutions (ETS); United States; On-site; USD 60,000 - 90,000; Full time

Job summary

Heraeus Group is seeking a Patient Access and Reimbursement specialist to verify insurance eligibility for advanced wound care and cellular tissue products, conduct benefit investigations across commercial, Medicare, and Medicaid payers, and determine patient financial responsibility.

You will maintain documentation, obtain prior authorizations, monitor statuses, escalate complex cases, and stay compliant with HIPAA and CMS.

Qualifications

• 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.

Responsibilities

• 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

Skills

Patient access experience

Prior authorizations

Medicare/Medicaid knowledge

Medical billing/coding

Communication skills

Education

High School Diploma

Bachelor's or Associate’s degree preferred

Tools

Salesforce Health Cloud

CRM systems

Job description

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

Heraeus is proud to be an employer that provides equal access to opportunities for all its employees. We provide fair and equal consideration to all qualified applicants, regardless of sex, gender identity, sexual orientation, race, color, religion, national origin, physical or mental disability, protected veteran status, age, or any other legally protected characteristic. A diverse and inclusive culture is at the heart of our Vision, Mission, and Values. We are dedicated to cultivating a workforce that reflects a broad spectrum of cultures, backgrounds, and perspectives.

We participate in E-Verify to confirm employment eligibility after hire. Learn more at www.e-verify.gov