Patient Qualification Specialist Jobs (NOW HIRING)

A Continued Qualification Specialist’s primary responsibility is to obtain all necessary documentation required by the patient’s insurance provider to continue qualified and authorized use of Ethos therapy products. This position plays a critical role in ensuring the seamless coordination of continued or transitioned therapy, facilitating efficient billing processes, and minimizing financial burdens for the payer, the patient and the product provider (Ethos). The role requires strong communication skills, a solid understanding of insurance policies and procedures, and the ability to work collaboratively with various stakeholders including patients, caregivers, clinical referral and payer sources. 

Qualifications

Responsibilities: 

1. Products: Acquire a deep understanding of Ethos products and their application and benefit to patient healing in the home. 
2. Communication:  A) Routine/scheduled contact with patients to verify active and compliant use of therapy products, active insurance coverage, and active healthcare providers.  B) Routine/scheduled contact with health care providers to obtain payer required documentation to maintain therapy in the home.  C) Routine/scheduled contact with in-house stakeholders to coordinate necessary and timely product transitions based on patients' eligibility for specific therapy determined by insurance guidelines and coverage limitations. 
3. Documentation: Maintain accurate and real-time records of clinical visits, patient assessments, patient demographics, insurance information, authorizations, coverage details and communication trail in digital platforms or designated database. 
4. Eligibility Assessment: Assess patients' eligibility for specific therapy determined by insurance clinical/compliance guidelines and coverage or contract limitations. 
5. Insurance Reauthorization: Perform necessary and timely reauthorization of patients' insurance coverage for continued therapy in the home, including reviewing clinical/compliance eligibility criteria, insurance plans, and benefits. 
6. Escalation: Timely escalate cases that have or could result in delayed claims submission or unbilled claims such as product transitions, non-compliance, denied appeals.  
7. Claim Processing: Collaborate with the billing department to ensure accurate and timely claim submissions, including the completion of necessary documentation and adherence to insurance company requirements. 
8. Problem Resolution: Investigate and resolve insurance-related issues, such as denied reauthorization claims and delays by working closely with insurance companies, patients, healthcare providers and in-house stakeholders. 
9. Compliance: Adhere to federal and state regulations, as well as insurance policies and guidelines, to maintain accurate and ethical practices in insurance reauthorization processes. 
10. Continuous Improvement: Identify opportunities for process improvements and collaborate with the team to enhance efficiency and effectiveness in continued qualification procedures. 

Qualifications: 

• High school diploma or equivalent; additional education in healthcare administration, medical billing, or related fields is preferred. 
• Proven experience in insurance verification within a medical or healthcare setting. 
• Comprehensive knowledge of various insurance plans, including private insurance, Medicare, Medicaid, and managed care organizations. 
• Familiarity with medical terminology, CPT codes, and ICD-10 coding system. 
• Proficient in using electronic health records (EHR) systems, insurance databases, and billing software. 
• Strong attention to detail with clear and concise written communication skills, excellent organizational skills, and the ability to stay on task. 
• Exceptional customer service skills, with the ability to verbally build relationships with various stakeholders. 
• Ability to work collaboratively with a diverse team including in-house staff, healthcare professionals, insurance representatives, and patients. 
• Proficiency in problem-solving and conflict resolution in insurance-related matters. 
• Knowledge of HIPAA regulations and commitment to maintaining patient confidentiality. 

Physical Requirements:  

• Must be able to remain in a stationary position for extended periods of time 
• Ability to sit or stand for extended periods of time 
• Constantly operates a computer and other office productivity machinery, such as a copy machine and computer printer  
• Ability to travel occasionally by car or commercial flight  

Ethos Therapy Solutions offers competitive benefits: medical, dental, vision, paid time off and 9 company paid holidays. Ethos Therapy Solutions is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, gender identity, veteran status, or military status. Ethos Therapy Solutions complies with all applicable federal, state and local laws concerning non-discrimination.

Applicants should apply online at https://ethosoutcomes.com/careers/

Ethos Therapy Solutions is a leading provider of therapy surfaces and specialty equipment for patients at home. Our portfolio of product solutions includes air fluidized therapy beds, Group 2 support surfaces, immersion therapy mattresses, and high-acuity frames.

Founded in 2008 as Star Medical Inc, we changed our name to Ethos Therapy Solutions in September of 2017 to reflect our culture of compassion and caring for patients with a pressure injury or managing the functional recovery of a trauma. Although our name has changed, our commitment to patients and caregivers remains the same. Our company values are integrity, respect, teamwork, and accountability and we are proud to embrace these principles as part of our daily mission.

Our simple process is designed to help patients receive the most medically appropriate product and improve their clinical outcomes – Collaborate, Learn, Heal.

Ethos Therapy Consultants collaborate with the healthcare team to align the ideal therapy surface or frame to the patient’s needs and treatment goals. Throughout the care episode, our clinical resource teams support the clinician to help navigate payer requirements, educate about therapy surface options and track patient progress using our proprietary Clinical Tracking Tool.

At Ethos, we know Outcomes Matter for patients at home.