Position Summary
The Funding Verification Specialist is responsible for verifying insurance benefits, determining appropriate funding and payment options, and assessing case viability to support successful device trials and procurement for Lingraphica devices.
Key Responsibilities
- Acquire insurance benefit coverage via phone or online portal.
- Interpret benefit coverage information to determine anticipated client costs.
- Evaluate the accuracy, completeness, and reliability of insurance benefit information and identify discrepancies or gaps that require additional verification.
- Assess case viability by reviewing expected reimbursement, payor requirements, funding criteria, and the likelihood of successful reimbursement before initiating a trial.
- Determine device trial funding options based on the patient’s insurance coverage.
- Identify potential coordination of benefits (COB) issues and work with the patient and/or care partner to resolve discrepancies.
- Review benefits for accuracy prior to sale.
- Communicate funding determinations, barriers, and next steps to internal teams and, when appropriate, patients and care partners.
- Maintain accurate and compliant documentation of insurance verification, funding determinations, patient records, and related communications.
- Track and trend issues to help prevent repeat problems.
- Complete administrative functions and data entry related to sales activities.
- Identify and escalate priority issues and follow up through resolution.
- Perform other duties and special projects as assigned.
Work Environment
- Remote role performed from a home office.
- Requires reliable and secure internet access.
- Limited travel by air, up to 2 times per year within the U.S.
Requirements & Qualifications
Qualifications
- High school diploma or GED required.
- Associate’s degree or equivalent combination of education and experience preferred.
- 3 years of experience in healthcare, insurance, DME, medical billing, benefits verification, or a related field required.
- Experience with Medicare, Medicaid, and commercial insurance required.
- Customer service and/or administrative support experience preferred.
- Experience with Microsoft Office, TrueSight, Inovalon, or HubSpot preferred.
Skills
- Knowledge of insurance plans, funding sources, and reimbursement processes related to durable medical equipment (DME).
- Strong data entry, documentation, and organizational skills.
- Strong attention to detail and accuracy.
- Effective verbal and written communication skills.
- Ability to work with clients who have speech impairments.
- Critical thinking, problem-solving, and independent judgment skills.
- Ability to manage multiple priorities in a fast-paced, process-driven environment.
- Ability to identify issues, recommend solutions, and escalate appropriately.
Benefits & Perks
Benefits
- Comprehensive benefits package.
- Competitive base pay.
- Starting salary range of $50,000 to $55,000 per year.
- Inclusive and supportive workplace.
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$50,000 - $55,000
Remote work allowed
Yes
Posted
1 week ago