Medical Authorization Specialist

Medical Authorization Specialist

As a key member of the Revenue Cycle Management team, you will play an integral part in helping Enovis drive the medical technology industry forward through transforming patient care and creating better patient outcomes.

High level position summary: Medical Authorization Specialist Representatives seek benefit coverage for patients from insurance groups with the responsibility of timely and compliant order entry, benefit verification and prompt follow up. This position works collaboratively with cross-functional internal and external teams to obtain necessary documentation required to obtain insurance authorizations.

Key responsibilities:

• Answers inbound and outbound calls, research, and identifies insurance to ensure compliant/proper account resolution.
• Verifies insurance eligibility and follows coordination of benefits guidelines.
• Determines revenue amounts based on allowable, benefits, unit price, payer guidelines, copayment, and contract pricing.
• Pursues supporting documentation from Sales Team to ensure all required documents are received prior to invoicing.
• Works to resolve submission issues which can include obtaining the appropriate Medical Record documentation or validation of coding.
• Appropriately challenges insurance companies by communicating information on Medical Necessity and negotiating coverage and pricing for the purchase of Enovis products that meet all applicable payor guidelines.
• Communicates with Management and Payor Development regarding payer trends.
• Maintains professional and technical knowledge by staying current on relevant products (both of Enovis and its competitors), reviewing clinical publications/studies, and establishing personal networks.
• Demonstrates commitment to the Compliance & Ethics Program, the Enovis Code of Conduct, the Enovis Sales and Marketing Code of Conduct, the AdvaMed Code of Ethics, and all supporting and applicable regulations, policies, and procedures.
• Other duties as assigned.

Minimum basic qualifications:

• High School Diploma or GED required.
• Minimum of 3 years of experience with compliant patient billing, customer service, claims processing or related experience in a health care environment required.
• Knowledge of ICD-10 coding, medical terminology, third party billing and collections, and managed care requirements required.
• Proficiency in Microsoft Office applications required.
• Strong attention to detail and passion for patient care and doing the right thing when decisions need to be made.
• Must have full understanding of customer service and compliant insurance follow-up processes (i.e., Billing, Collections, Managed Care, Medicare, Medicaid, and Commercial payor practices).
• Experience responding to patient and insurance inquiries preferred.
• Experience using DataWorks, Computers Unlimited TIMS, or similar case management software strongly preferred.

Travel requirements:

• This position does not require travel.

Desired characteristics:

• Exhibit a strong desire for technical knowledge, skills, and judgment to effectively serve customers and achieve goals.
• Demonstrates excellent attention to detail.
• Communicates effectively at all levels of an organization.

Currently, Enovis does not provide sponsorship for employment visas (e.g., H-1B) and will not offer such sponsorship in the future. Applicants must already have full-time work authorization in the United States, both now and in the future, without requiring sponsorship.

Join us in creating better together.

We offer a comprehensive benefits package that includes:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Spending and Savings Accounts
• 401(k) Plan
• Vacation, Sick Leave, and Holidays
• Income Protection Plans
• Discounted Insurance Rates
• Legal Services

EQUAL EMPLOYMENT OPPORTUNITY Enovis provides equal employment opportunities based on merit, experience, and other work-related criteria without regard to race, color, ethnicity, religion, national origin, sex, age, pregnancy, disability, veteran status, or any other status protected by applicable law. We also strive to provide reasonable accommodation to employees' beliefs and practices that do not conflict with Enovis policies and applicable law. We value the unique contributions that every employee brings to their role with Enovis.