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16 days ago
Requirements and responsibilities
About OX BioMedOX BioMed supports clinical providers with advanced skin substitutes, streamlined logistics, and responsive services so they can treat patients with confidence. OX BioMed was custom built to meet the unique needs of wound care practices in this ever changing, fast past, and often chaotic operating environment. Founded by industry veterans with a passion for patients and a focus on systems and support. Whether you are a provider, office staff, or a sales agent, we are here to make your life easier.About the roleThis is a full-time remote role for Clinical Case Manager. The case manager will be responsible for verifying patient insurance coverage/benefits using online portals or calling the Payor directly for accuracy. The case manager will be required to document coverage results in our online software application, review patient clinical for payor medical necessity and initiate prior authorization or predetermination with payor. Follow up with payor and maintain communication with sales team and customer. Report out the patient benefits and authorization/predetermination results to external customers via online application or email/fax. In the case of a denial, work with the customer and payor through the appeal process. This role requires strong clinical background and understanding of standard wound care, strong computer skills to navigate through multiple software applications in a fast-paced environment, the ability to work independently, and a detail-oriented person who can provide accurate, best-in-class service to our customers.What you'll doComplete insurance benefit and coverage verifications via online portals and/or phoneDocument benefit and coverage results in the online applicationInitiate prior authorization and pre-determination submissionsAppeals support as neededCommunicate professionally with health insurance payers, external customers, and sales team via phone and emailTranscribe data from various sources into databases, ensuring data integrity and HIPAA complianceQualificationsClinical qualifications such as RN, LPN or medical assistant2-4 years of experience is preferredUnderstanding of health insurance plans, patient benefits, and coverage is preferredTech-savvy with the ability to adapt to system changesProficient in Excel and AdobeExcellent written and verbal communication skillsPrivate home office space with high-speed internet
Optionally, you can add more information later (benefits, pre-screening questions, etc.)