WHO ARE WE?
Wound Pros Management Group, Inc., and its affiliated professional corporations nationwide (collectively, the Wound Pros), is the nation’s largest wound care management company in 19 states and counting. Our mission is to facilitate the standardization of evaluating and treating chronic wounds in long-term care facilities by leveraging the power of AI and technology. We offer essential services, including Digital Wound Management, Telemedicine, Advanced EHR Systems, Mobile Vascular Assessment, Digital Supply Tracking, Advanced Wound Care Dressings, and Medicare Part B provider participation.
Kickstart your career by joining many professionals committed to healing wounds and saving lives. At Wound Pros Management Group Inc., we pride ourselves on being inclusive of other's thoughts, perspectives, and backgrounds as we seek to embody our core values “LINK” -We Listen, Innovate, Never give up, and ‘Kultivate’ & grow.
JOB SUMMARY
The Commercial Insurance Eligibility Verification Analyst is critical in ensuring timely
and accurate verification of insurance benefits for patients with commercial health plans. This
position requires strong communication skills to coordinate effectively across clinical, billing,
and intake teams while ensuring patients are appropriately informed of their insurance status and financial obligations. The analyst helps minimize claim denials, supports clean claim submission, and contributes to an efficient revenue cycle.
WHAT ARE YOUR ASSIGNMENTS
- Conduct eligibility verification and benefit investigations for commercial insurance plans using payer portals, clearinghouses, or direct phone calls.
- Review insurance coverage for scheduled services, including benefit limits, authorization requirements, and cost-sharing responsibilities.
- Document eligibility findings and payer responses in the EMR or practice management system.
- Communicate insurance status, required authorizations, and service limitations to internal departments (billing, referrals, clinical, and scheduling) clearly and promptly.
- Escalate discrepancies or coverage conflicts to leadership with appropriate documentation and recommendations.
- Collaborate with front office and referral teams to ensure all patients have active, billable insurance coverage before the service date.
- Follow up on pending verifications and payer inquiries with professionalism and persistence.
- Maintain accurate records of payer communications and regularly update reference guides on payer-specific rules.
- Participate in cross-functional meetings to review verification trends and support continuous improvement in the eligibility workflow.
- Excellent written and verbal communication skills when interacting with patients, insurance carriers, and internal stakeholders.
WHAT YOU HAVE ALREADY ACHIEVED
- High School Diploma or equivalent required; associate's or bachelor’s degree in
- Healthcare administration or related field preferred.
- Minimum 2 years of experience in insurance verification, billing, or revenue cycle operations, emphasizing commercial payers.
- Strong verbal and written communication skills with the ability to clearly explain insurance coverage details to both clinical and non-clinical staff.
- Experience using payer portals (e.g., Availity, UHC, Aetna, Cigna) and eligibility systems (e.g., Waystar, Experian).
- Knowledge of medical terminology, ICD-10, CPT/HCPCS coding, and basic claims workflow.
- Ability to handle sensitive patient information with confidentiality and professionalism.
- Proficient in Microsoft Office and EMR/practice management systems such as DrChrono, Tebra, or Athena.
ATTRIBUTES NEEDED FOR THE ROLE
- Experience in specialty care, DME, wound care, or home health eligibility verification.
- Familiarity with prior authorization requirements and denial prevention strategies.
- Strong analytical skills and attention to detail with the ability to manage competing priorities.
- Comfortable with remote communication tools (e.g., Teams, Zoom, Slack) for coordination across departments.
EQUAL OPPORTUNITY EMPLOYER
Wound Pros Management Group Inc. is an equal opportunity employer focused on being more than just a great workplace; we are committed to fostering an inclusive and supportive work environment for everyone. We strive to recruit and maintain a diverse workforce. Qualified applicants will receive consideration for employment without regard to race, physical or mental disability, color, religious creed, ancestry, national origin, religion, age, sex, marital status, genetic information or testing, gender identity and expression, sexual orientation or status as a Vietnam-era or special disabled veteran or any characteristic protected by law.
Please note: Only shortlisted applicants will be contacted for Interviews.
