Insurance Verification Specialist in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Insurance Verification Specialist based in the United States.

This role supports timely patient access to advanced wound care and cellular tissue therapies by managing insurance verification and reimbursement-related activities.
You will investigate coverage across commercial, Medicare, Medicaid, and managed care payers to determine eligibility and financial responsibility.
The position combines payer research, prior authorization support, documentation, case management, and provider communication.
You will work closely with providers, payer representatives, sales teams, and reimbursement specialists to resolve coverage challenges and prevent treatment delays.
A strong understanding of healthcare reimbursement policies, medical coding, and payer requirements will be essential to success.
You will also monitor authorization activity, maintain accurate records, and stay current with evolving reimbursement policies and regulations.
This is an opportunity to make a direct impact on patient access while contributing to a high-quality, compliant healthcare support operation.

• Verify patient insurance eligibility, benefits, and coverage for advanced wound care and cellular tissue products.
• Conduct detailed 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 and reimbursement cases while communicating with payer case managers, healthcare providers, sales teams, and field reimbursement personnel.
• Escalate complex eligibility, coverage, and reimbursement issues to the appropriate stakeholders.
• Review payer medical policies and coverage criteria applicable to cellular tissue products and wound care therapies.
• Identify prior authorization, pre-certification, referral, and other payer-specific requirements.
• Obtain, track, and document authorization requirements and status throughout the reimbursement process.
• Maintain accurate records of payer communications, verification results, authorization status, and patient account information within CRM or reimbursement management systems.
• Monitor authorization approvals, denials, and pending requests and conduct timely follow-up to minimize delays in patient treatment.
• Assist healthcare providers with collecting and submitting clinical documentation required for insurance approvals.
• Identify payer-specific billing requirements, coding guidelines, and documentation standards relevant to cellular tissue products.
• Monitor changes to Medicare Local Coverage Determinations (LCDs), commercial payer policies, and reimbursement requirements affecting wound care products.
• Maintain compliance with HIPAA, CMS regulations, FDA guidelines, internal policies, and applicable healthcare laws.
• Meet established productivity, quality, and turnaround-time standards for insurance verification and reimbursement activities.
• Provide professional, responsive, and confidential service to patients, providers, payers, and internal stakeholders.
• Participate in departmental meetings, training sessions, and in-services as required.

Requirements

• At least 5 years of experience in patient access, reimbursement support, medical billing, medical coding, or a closely related healthcare function.
• Demonstrated expertise in prior authorizations, appeals, benefit investigations, and insurance verification.
• Strong working knowledge of Medicare, Medicaid, managed care, and commercial payer policies and processes.
• Experience with medical coding systems, including CPT, HCPCS, and ICD-10-CM, particularly as they relate to wound care and surgical or interdisciplinary services.
• High school diploma required; an associate or bachelor’s degree in a relevant field is preferred.
• Experience in wound care or related therapeutic areas, such as advanced wound dressings, skin substitutes, or biologics, is preferred.
• Experience using case management, reimbursement, or CRM platforms, including Salesforce Health Cloud or similar systems, is advantageous.
• Background supporting medical devices or healthcare services in hospital or physician office environments is preferred.
• Strong written and verbal communication skills, with the ability to communicate clearly with providers, payers, and internal teams.
• Excellent attention to detail and documentation skills, particularly when handling complex insurance and authorization information.
• Strong organizational and follow-up abilities, with the capacity to manage multiple cases and deadlines simultaneously.
• Demonstrated personal accountability and commitment to improving patient access and customer outcomes.
• Ability to maintain strict confidentiality and handle sensitive patient information in accordance with HIPAA and applicable privacy requirements.
• Strong understanding of healthcare compliance and the ability to adapt to changing payer policies and reimbursement requirements.

Benefits

• Permanent, full-time employment opportunity.
• Remote work arrangement within the United States.
• Opportunity to directly support patient access to advanced wound care and cellular tissue therapies.
• Collaborative environment involving healthcare providers, payer representatives, reimbursement specialists, sales teams, and other stakeholders.
• Opportunity to develop expertise across patient access, reimbursement, insurance verification, and healthcare market access.
• Exposure to Medicare, Medicaid, commercial payer policies, medical coding, and evolving reimbursement requirements.
• Opportunity to contribute to process quality, timely treatment access, and improved patient and provider experiences.