Wound Care Insurance Approval Coordinator (Remote)

Wound Care Insurance Approval Coordinator (Remote)

Do you have a meticulous eye for detail and a passion for helping patients access the care they need? Are you experienced in navigating insurance guidelines, prior authorizations, and the specialized world of wound care? If so, NIVA Health invites you to apply for our Remote Wound Care Advanced Insurance Approval Coordinator position!

At NIVA Health, our mission is simple: helping people heal. Every day, our nationwide team stands shoulder to shoulder, delivering compassionate, expert care to patients who deserve to live healthier, fuller lives. As a key member of our authorization coordination team, you will play a pivotal role in ensuring patients receive timely, necessary treatment, all while exemplifying our Core Values of Teamwork, Resilience, Open-Mindedness, Ownership, and Positivity.

In This Role, You’ll

• Submit and manage prior authorization requests for wound care treatments, ensuring that all documentation meets payer requirements
• Handle PCP referrals/authorizations and follow up to facilitate smooth patient care
• Prepare and track Single Case Agreements (SCAs)/GAP exceptions for out-of-network cases
• Communicate with insurance providers to clarify coverage, resolve denials, and facilitate appeals
• Maintain precise records of authorizations, denials, appeals, and corresponding documentation in Athena EHR
• Stay up to date with insurance policies, coding changes, and criteria for wound care procedures
• Collaborate with providers, nurses, and admin staff to gather complete, accurate documentation for submissions
• Serve as a patient advocate, keeping patients informed about the status of their authorizations and potential out-of-pocket expenses
• Conduct your work with utmost discretion, diplomacy, and tact during all patient and staff interactions
• Contribute to other duties of similar complexity as assigned by your supervisor

You’re a Great Fit If You

• Possess at least 1 year of experience in prior authorization management, specifically within wound care services
• Have direct experience with PCP referrals/authorizations, GAP exceptions, and Single Case Agreements
• Are proficient with Athena EHR (required)
• Demonstrate a strong work ethic, self-motivation, and a “can-do” attitude
• Communicate clearly, empathetically, and professionally with patients, staff, and payers
• Understand the intricacies of insurance processes, medical terminology, and healthcare systems
• Excel at collaborating with multidisciplinary healthcare teams and solving complex problems
• Embody NIVA Health’s Core Values in every interaction with patients and colleagues

Bonus Points If You

• Are experienced in handling appeals, denials, and insurance exception requests
• Bring innovative approaches to patient advocacy and insurance coordination
• Stay informed about industry trends, especially in advanced wound care and insurance policy changes

Why Join Us?

At NIVA Health, your efforts are instrumental in making sure patients receive the life-changing care they deserve. We celebrate our team’s achievements, invest in your personal and professional growth, and provide meaningful work in a values-driven, supportive environment. Join us and help shape a brighter, healthier future for all—one successful authorization at a time!

Pay: $1,300 per month

Work Schedule: US Timezone (East Coast)

Job Type: Full-time

Work Location: Remote