Careers

Description

CHARACTERISTICS OF THE POSITION:  

The Insurance Verification Specialist plays a critical role in ensuring accurate, timely verification of insurance benefits and requirements to support Venture Medical, LLC’s wound care solutions. This position is responsible for serving as a subject matter expert in insurance verification processes, partnering closely with internal teams, including Systems Development and Relationship Managers, to build and refine the company’s insurance verification platform. The role requires strong technical, analytical, and customer service skills to support providers and payers.

ESSENTIAL DUTIES:

·      Perform complete and accurate patient/client setup and full insurance benefits verification, including contacting payers to confirm coverage, requirements, and patient financial responsibility.

·      Facilitate processes for requesting Medical Authorizations and Prior Authorizations for medical claims.

·      Serve as subject matter expert for insurance verification requests; provide direction, troubleshooting, and quality oversight.

·      Develop, maintain, and deliver training materials related to IVRs, insurance verification processes, and payer requirements; train internal teams and partner providers.

·      Collaborate closely with Systems Development to provide functional requirements, feedback, and testing support for the Insurance Verification platform and related digital tools.

·      Work with external providers to support patients with documentation needs and appeals for denied claims, and follow-up with payers on outcomes.

·      Monitor and follow up on unpaid claims and outstanding collections items; identify trends and escalate at-risk accounts to management.

·      Participate in third-party, Medicare, and medical provider claim audits to help minimize financial exposure.

·      Provide feedback to management and providers to ensure accurate claim submission and process improvement.

·      Maintain accurate, complete documentation in CRM and associated systems.

·      Monitor changes to insurance coverage and update providers and internal stakeholders as needed.

·      Plan and organize daily workload to meet productivity expectations and SLA requirements.

·      Other duties as assigned.

RELATED DUTIES:

·      Assist with data analysis and reporting on insurance verification trends, payer performance, and operational opportunities.

·      Participate in cross-functional projects related to digital solutions, workflow enhancement, and payer process optimization.

MINIMUM QUALIFICATIONS:

Training and Experience

·      3+ years of experience in insurance verification, medical billing, healthcare administration, or a related field.

·      Experience in wound care, DME, medical devices, or specialty care preferred but not required.

·      Prior experience developing training materials or training others on IVRs, insurance verification, or payer procedures strongly preferred.

·      Experience with CRM platforms required.

·      Project management experience a plus.

·      HIPAA compliance knowledge required.

Knowledge, Abilities and Skills

·      Knowledge of commercial insurance, Medicare/Medicaid, payer policies, prior authorization requirements, and medical terminology.

·      Deep understanding of insurance verification workflows, documentation requirements, and appeals processes.

·      Ability to navigate complex insurance calls and communicate professionally with payers, healthcare providers, and internal teams.

·      Strong verbal communication skills; comfortable handling high-volume phone interactions.

·      Ability to analyze data, identify trends, and propose solutions.

·      High comfort level with technology; able to learn new digital platforms quickly and provide feedback to development teams.

·      Strong organizational skills with the ability to manage multiple priorities and meet deadlines.

·      Excellent customer service mindset with the ability to problem-solve in real time.

·      Ability to work independently and collaboratively in a fast-paced environment.

PHYSICAL REQUIREMENTS:

·      Prolonged periods of sitting and working at a computer.

·      Occasional lifting of up to 10 pounds.

·      Manual dexterity for keyboarding and telephone use.

Working Conditions

·      Office environment with a collaborative and dynamic team atmosphere.

·      Hybrid or remote working arrangements may be considered depending on business needs.

·      Minimal travel may be required for training or team meetings.

Date: 12/17/2025

Venture Medical, LLC, is committed to diversity and inclusion in the workplace. Individuals seeking employment at Venture Medical, LLC, are considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, ancestry, disability, veteran status, or other legally protected characteristics. Reasonable accommodations available.

Salary

$75,000 - $90,000 per year

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