Qualification Specialist

2 months ago

Miramar, United States Vohra Wound Physicians Full time $55,000 - $60,000
Job Purpose:  The Qualification Specialist is responsible for managing and overseeing the processes related to the verification and authorization of services provided within healthcare facilities, particularly focusing on nursing home physician rounds. This position acts as a critical liaison between various stakeholders, ensuring efficient operations and compliance with regulations. The Qualification Specialist reports to the Associate Director of Operations Key Responsibilities:
  • Service Verification: Efficiently and accurately verify SK/NSK services, including specialty services, ensuring all necessary documentation and approvals are obtained.
  • Communication: Maintain effective communication with a diverse group of individuals, including healthcare facilities, clinicians, vendors, and insurance payers.
  • Order Processing: Manage the end-to-end process of order processing, including monitoring packing slips, delivery tracking, and ensuring timely fulfillment of orders.
  • Authorization Requests: Work with vendors and insurance payers to accurately request and secure authorizations for scheduled services.
  • Additional Duties: Perform other duties as assigned by the Associate Director to support the overall operations and objectives of the department.
 Knowledge and Skills:
  • Communication Skills: Excellent verbal and written communication skills, with the ability to effectively interact with internal and external stakeholders.
  • Medical Knowledge: Proficient understanding of medical insurance processes, authorization procedures, and some medical terminology.
  • Collaboration: Ability to collaborate across departments and build effective relationships to achieve organizational goals.
  • Organizational Skills: Strong organizational skills with the ability to prioritize tasks, multitask, and manage time effectively.
  • Team Environment: Promote a positive team environment that reflects the organization’s culture and values.
 Experience:
  • Eligibility and Inquiry Responses: Experience with 270/271 eligibility and inquiry responses.
  • Healthcare Facilities: Preferred experience working with Skilled Long-Term Care facilities.
  • Technical Proficiency: Intermediate proficiency with PC and Windows applications, including Excel.
  • Software Experience: Preferred experience with Point Click Care and Matrix software.
 Qualifications:
  • Minimum of 2-3 years of experience in a healthcare or insurance environment, particularly in roles involving service verification and authorization.
  • Strong analytical and problem-solving skills.
  • Ability to work independently and as part of a team.
  • Detail-oriented with a high level of accuracy.


About Vohra Wound Physicians:

Founded in 2000, Vohra Wound Physicians is the largest wound care specialty practice focused exclusively on the post-acute sector, and the premier provider and employer in wound management. The company provides bedside clinical care to hundreds of thousands of patients annually at nearly 3,000 skilled nursing facilities across 28 states as well as to patients healing at home via telemedicine. Supported by proprietary technologies and extensive, ongoing physician training, Vohra delivers results including a 21-day improvement in healing time and an 88% reduction in wound-related hospitalizations. Our mission: to improve patient outcomes and reduce hospitalizations while reducing costs for facilities and home health partners.Vohra is seeking top doctors across the nation to join our practice. Please contact us today to learn more.www.vohrahysicians.com

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