Cardiac Diagnostic Reimbursement Specialist

CMS At ZOLL, we're passionate about improving patient outcomes and helping save lives. We provide innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and treat patients suffering from serious cardiopulmonary and respiratory conditions. ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed to deliver better insights and better outcomes. On any given day, clinicians utilize these ZOLL products for tens of thousands of cardiac patients around the world: LifeVest , the world's first wearable defibrillator, has been trusted to protect more than 1M patients at risk of sudden cardiac death. HFMS (Heart Failure Management system) is a non-invasive, patch-based device that monitors pulmonary fluid levels and has been shown to reduce heart failure readmissions rates by 38 percent. TherOx Super Saturated Oxygen (SSO2) Therapy is the first FDA-approved therapy since the stent 20+ years ago to reduce infarct size in patients with the most severe heart attacks. Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. ZOLL has been Pittsburgh's Manufacturer of the Year, one of Western PA's Healthiest Employers, and even one of Pittsburgh's Coolest Offices. But it's our unique opportunity to impact people's lives that makes ZOLL the ideal place to build your career. Job Summary The Intake Specialist is an integral member of the reimbursement team and has primary responsibility for the timely handling of new medical orders from hospitals and physician offices. This individual is responsible for front-end functions of the order fulfillment process. Individual will work with numerous insurance types in reviewing medical orders and clinical documentation to determine benefit and clinical eligibility for the LifeVest. Individual is responsible for creating and maintaining relationships with insurance companies, sales reps, and other internal departments. Essential Functions Creation of patient record Verification of benefits Triage, work and resolve intake orders Explain medical need and educate insurance case managers on LifeVest system to obtain authorization for services Obtain necessary documentation (medical order, clinical notes, testing) and submit to insurance carrier for coverage determination Obtain authorizations as required by payer Execute timely follow up on all assigned tasks Maintain a score of at least Meets Expectations on monthly scorecard Identify qualifying diagnosis based on payer requirements Triage fax documents for timely review Communicate authorization results and order status to sales representatives Complete fee calculator and inform billing department of appropriate charges Contact customers, physician offices, and sales representatives to relay and/or obtain insurance information and/or additional documentation to assist with seeking reimbursement and coordination of benefits Required/Preferred Education and Experience High School Diploma required Associate's Degree or Bachelor's Degree in nursing, business, or other related field preferred minimum of 2 years insurance verification experience required OR internal candidates with a minimum of 1 year experience supporting medical providers or patients in a phone queue. Knowledge, Skills and Abilities Superior communication; both verbal and written Strong customer service skills Proficiency in navigating several software systems concurrently Aptitude to handle multiple tasks simultaneously under strict deadlines Attention to detail Superior organizational and time management skills Ability to communicate policy information in a clear and detailed manner Proficiency with MS Office Suite Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Standing - Occasionally Walking - Occasionally Sitting - Constantly Talking - Occasionally Hearing - Occasionally Repetitive Motions - Frequently ZOLL is a fast-growing company that operates in more than 140 countries around the world. Our employees are inspired by a commitment to make a difference in patients' lives, and our culture values innovation, self-motivation and an entrepreneurial spirit. Join us in our efforts to improve outcomes for underserved patients suffering from critical cardiopulmonary conditions and help save more lives. #LI-KH1 The hourly pay rate for this position is: $19.00 to $23.00 Factors which may affect this rate include shift, geography, skills, education, experience, and other qualifications of the successful candidate. Details of ZOLL's comprehensive benefits plans can be found at www.zollbenefits.com . Applications will be accepted on an ongoing basis until this position is filled. For fully remote positions, compensation will comply with all applicable federal, state, and local wage laws, including minimum wage requirements, based on the employee’s primary work location. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, disability, or status as a protected veteran. ADA: The employer will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990.