About Our Company

Advanced Diabetes Supply® was founded on the bold principle of creating a knowledgeable, reliable and demonstrably superior diabetes supply company. Our approach, coupled with a commitment to service and innovation, has catapulted Advanced Diabetes Supply® to a national leader in the industry. Creating high-performance, adaptive teams requires a relentless commitment to hiring the best. We strive to maintain a casual, fun environment whenever possible, but we don’t just play around. We work hard every day to provide a positive work culture and respectful atmosphere. The standards we set for ourselves are high, and we love to be challenged! If you enjoy working in a collaborative environment, have a passion for excellence and a bias for action, we may be just what you’ve been looking for.

Interested in learning more about our company and its culture? Visit us at www.northcoastmed.com

About The Position

Hours: 8:30 AM to 5:00 PM ET, Monday to Friday

Location: Remote

The Insurance Verification Specialist II is a senior member of the insurance verification team, responsible for performing complex insurance verifications and resolving challenging insurance-related issues. They work under the guidance of the Insurance Verification Supervisor, utilizing their expertise to ensure accurate insurance coverage and billing information.

Essential Functions

• Conducts in-depth insurance verifications for complex cases, such as multiple insurance coverages or specialized procedures.
• Researches and interprets insurance policies and benefits to determine coverage and eligibility for medical services.
• Collaborates with insurance carriers and healthcare providers to address insurance-related inquiries and resolve issues.
• Manages the pre-authorization process for high-level medical procedures and services, ensuring compliance with payer requirements.
• Advocates for patients to obtain necessary authorizations and navigate insurance coverage challenges.
• Evaluates authorization denials and appeals, providing documentation and support as needed.
• Reviews and analyzes insurance claims for accuracy and completeness before submission.
• Investigates and resolves complex insurance-related billing issues and claim rejections.
• Provides guidance and training to junior insurance verification specialists on billing procedures and best practices.
• Assists in conducting audits of insurance verification processes to ensure compliance with industry standards and regulations.
• Identifies opportunities for process improvements and recommend solutions to enhance efficiency and accuracy.
• Serves as a subject matter expert on insurance verification policies and procedures.
• Embraces and exemplifies ADS core values:

• We put our people first.
• We serve our members with passion.
• We take ownership.
• We pursue excellence.
• We never stop growing.

Other Responsibilities

• May perform any additional responsibilities or special projects as required.
• May provide cross-functional support as business needs demand.
• Duties and responsibilities may be subject to change based upon the needs of the department.

• High school diploma or equivalent (GED).
• Minimum of 2 years of experience in healthcare insurance verification or related role.
• Advanced knowledge of medical insurance terminology, policies, and procedures.
• Skilled in using EHR systems, insurance verification software, and Microsoft Office applications.

Expected Competencies

• Friendly, professional, and effective communications skills; able to calmly present solutions in challenging situations.
• Proactive identification of challenges, and solution-oriented approach to problem solving.
• Service-orientation and aptitude to utilize proper listening skills.
• Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.
• Self-directed accountability and reliability
• Effective communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.
• Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.
• Able to work well in a team environment that promotes inclusiveness and communication among team members.
• Communication using both verbal and written English proficiency.
• Cultural competence

Physical Demands

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable employees with disabilities to perform the essential functions.

While performing the responsibilities of the job, the employee is required to remain in a stationary position most of the time (stand or sit). While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is frequently required to stand, walk, and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

Other Requirements

• Candidates must successfully pass a background check.
• Candidates must be able to provide proof of eligibility to work in the United States without sponsorship.

Compensation Package

Pay ranges may vary depending on location. The general pay range for this position is $19.00 - $21.00 per hour. Actual compensation depends on education, experience, and relevant skills. In addition, benefits include:

• Health, Dental & Vision options
• FSA and HSA plan with Employer Contribution
• Employer paid EAP
• 401k with 4% Company Match
• Discretionary Profit-Sharing Plan
• Paid Time Off (PTO) Including 7 Paid Holidays and a Birthday Holiday
• On-Site Gym
• In-house Training Programs
• A fun culture in a fast-growing organization!

Equal Opportunity Statement

Advanced Diabetes Supply® provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.