Change of Benefits Specialist

Location: Pittsburgh, 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 Change of Benefits Specialist is an integral member of the reimbursement team and has primary responsibility for the timely handling of accounts with a change to insurance coverage. This 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 team, and other internal departments.

Duties and responsibilities

  • Verification of benefits
  • Explaining medical need and educating insurance case managers on LifeVest system to obtain authorization for services
  • Obtaining necessary documentation (forms, clinical notes, testing) and submitting to insurance carrier for coverage determination
  • Obtaining authorizations from insurance companies
  • Communicating authorization requirements and results to sales representatives
  • Negotiating favorable rates with insurance companies with guarantee of assignment of benefits
  • Completing fee calculator and informing billing department of appropriate charges
  • Contacting 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
  • Performs other duties as assigned by management

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skills and abilities required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.

  • 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
  • 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

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; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to walk. The employee must occasionally lift and/or move up to 10 pounds.

Supervisory responsibility

None

ZOLL is an Equal Opportunity Employer  minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity

Equal Opportunity Employer-Disability and Veteran

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