Funding Verification Specialist - Remote

Essential Duties & Responsibilities

• Acquire insurance benefit coverage via phone or online portal
• Interpret benefit coverage information to determine anticipated costs for clients
• Evaluate the accuracy, completeness, and reliability of insurance benefit information and identify discrepancies or gaps requiring additional verification
• Absess case viability by evaluating expected reimbursement, payor requirements, funding criteria, and the likelihood of successful reimbursement prior to initiating a trial
• Determine device trial funding options based on the patient’s insurance coverage
• Recognize and identify potential coordination of benefits (COB) issues and proactively engage with the patient and/or care partner to gather information and assist in resolving discrepancies
• Review benefits for accuracy prior to sale
• Clearly communicate funding determinations, potential barriers, and recommended next steps clearly to internal teams and, when appropriate, patients and care partners
• Maintain accurate, complete, and compliant documentation of insurance verification, funding determinations, patient records, and related communications in accordance with HIPAA, Medicare, and organizational requirements
• Proactively communicate with team members regarding identified potential issues and concerns
• Maintain patient records according to HIPAA and Medicare guidelines
• Track and trend issues to aid in the resolution and prevention of repeat problems
• Complete all administrative functions, such as data entry, associated with sales activities in a timely manner and in accordance with established processes
• Identify and escalate priority issues and proactively follow up on tasks
• Perform other duties and special projects as assigned

Qualifications

• Knowledge of insurance plans, funding sources, and reimbursement processes related to Durable Medical Equipment (DME)
• Strong data entry, documentation, and organizational skills with a high level of accuracy and attention to detail
• Methodical approach to gathering information, conducting research, and resolving issues effectively
• Effective verbal and written communication skills with a professional, customer-focused approach
• Compassion for individuals with disabilities and the ability to communicate effectively with clients who have speech impairments
• Ability to build rapport and maintain professionalism when interacting with clients, caregivers, providers, and internal stakeholders
• Strong critical thinking and problem-solving skills, with the ability to assess risk and make informed decisions
• Ability to exercise sound independent judgment within established guidelines and appropriately escalate complex or high-risk situations
• Ability to identify alternative solutions, evaluate options, and recommend appropriate courses of action
• Demonstrates adaptability in response to changing priorities, processes, and business needs
• Exhibits innovative thinking and a willingness to explore new approaches to improve outcomes and efficiency
• Open to giving and receiving feedback, with a commitment to continuous learning and professional growth
• Ability to manage multiple priorities and maintain consistent performance in a fast-paced, process-driven environment
• Strong attention to detail while balancing productivity, quality, and timeliness
• Maintains a sense of urgency and takes ownership of responsibilities through to resolution
• Proactive, solutions-oriented mindset with the ability to anticipate challenges and address them effectively
• Demonstrates accountability, follow-through, and ownership of assigned work
• Takes initiative to identify opportunities for improvement and contribute to team and organizational success

Skills And Competencies

• Knowledge of insurance plans, funding sources, and reimbursement processes related to Durable Medical Equipment (DME)
• Strong data entry, documentation, and organizational skills with a high level of accuracy and attention to detail
• Methodical approach to gathering information, conducting research, and resolving issues effectively
• Effective verbal and written communication skills with a professional, customer-focused approach
• Compassion for individuals with disabilities and the ability to communicate effectively with clients who have speech impairments
• Ability to build rapport and maintain professionalism when interacting with clients, caregivers, providers, and internal stakeholders
• Strong critical thinking and problem-solving skills, with the ability to assess risk and make informed decisions
• Ability to exercise sound independent judgment within established guidelines and appropriately escalate complex or high-risk situations
• Ability to identify alternative solutions, evaluate options, and recommend appropriate courses of action
• Demonstrates adaptability in response to changing priorities, processes, and business needs
• Exhibits innovative thinking and a willingness to explore new approaches to improve outcomes and efficiency
• Open to giving and receiving feedback, with a commitment to continuous learning and professional growth
• Ability to manage multiple priorities and maintain consistent performance in a fast-paced, process-driven environment
• Strong attention to detail while balancing productivity, quality, and timeliness
• Maintains a sense of urgency and takes ownership of responsibilities through to resolution
• Proactive, solutions-oriented mindset with the ability to anticipate challenges and address them effectively
• Demonstrates accountability, follow-through, and ownership of assigned work
• Takes initiative to identify opportunities for improvement and contribute to team and organizational success

Education And Experience

• High School Diploma or GED, required
• Associate's degree or equivalent combination of education and experience, preferred
• 3 years of healthcare, insurance, DME, medical billing, benefits verification, or related experience, required
• Experience with Medicare, Medicaid and Commercial insurance, required
• Experience in customer service and/or administrative support, preferred
• Experience with Microsoft Office, TrueSight, Inovalon, or HubSpot, preferred