Clinical Review Intake Specialist - Remote

Location: Remote, PA

Cardiac Management Solutions

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.

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. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives.

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 purpose

The Intake Specialist – Diagnostic Testing 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 Diagnostic Testing. Individual is responsible for creating and maintaining relationships with insurance companies, sales reps, and other internal departments.

Duties and responsibilities

  • Front to end Intake process including order creation, benefit verification of Medicare, Medicaid, and commercial policies, documentation collection (Medical Order, clinical notes, testing), Identify qualifying diagnosis based on payer requirements and authorization submission/ timely follow-up.
  • Triage, work and resolve intake orders and faxes coming into the office.
  • Explain medical need and educate insurance case managers on ZOLL systems to obtain authorization for services
  • Maintain a score of at least Meets Expectations on monthly scorecard
  • 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 clinical documentation to assist with seeking reimbursement and coordination of benefits
  • Complete a change of benefits when patients change insurances while monitoring  
  • Performs other duties as assigned by management

Qualifications

  • Experience with Home Sleep Studies preferred
  • Experience with Diagnostic Testing preferred
  • H.S. Diploma or equivalent required. Associate’s or Bachelor’s degree in nursing, business, or other related field preferred
  • 2-3 years insurance verification experience
  • Superior communication; both verbal and written
  • Strong customer service skills and attention to detail
  • Proficiency in navigating several software systems concurrently
  • Aptitude to handle multiple tasks simultaneously under strict deadlines
  • Superior organizational and time management skills
  • Ability to communicate policy information in a clear and detailed manner
  • Proficiency with MS Office Suite

Working conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet.

Physical requirements

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Supervisory responsibility

None

AAP/EEO Statement

ZOLL is committed to fostering an inclusive workplace, where unique identities, backgrounds, cultures, perspectives and experiences are respected and valued.

Equal Opportunity Employer – Disability and Veteran