Dispensing Specialist - M-F 1 pm - 9:30 pm

CMS
At ZOLL, we're passionate about improving patient outcomes and helping save lives. We provide innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and treat patients suffering from serious cardiopulmonary and respiratory conditions.

ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed to deliver better insights and better outcomes. On any given day, clinicians utilize these ZOLL products for tens of thousands of cardiac patients around the world:

- LifeVest, the world's first wearable defibrillator, has been trusted to protect more than 1M patients at risk of sudden cardiac death.

- HFMS (Heart Failure Management system) is a non-invasive, patch-based device that monitors pulmonary fluid levels and has been shown to reduce heart failure readmissions rates by 38 percent.

- TherOx Super Saturated Oxygen (SSO2) Therapy is the first FDA-approved therapy since the stent 20+ years ago to reduce infarct size in patients with the most severe heart attacks.

Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need.

ZOLL has been Pittsburgh's Manufacturer of the Year, one of Western PA's Healthiest Employers, and even one of Pittsburgh's Coolest Offices. But it's our unique opportunity to impact people's lives that makes ZOLL the ideal place to build your career.

Job Summary

The Dispensing Specialist is an integral member of the reimbursement team and has primary responsibility for the timely handling of new medical orders from hospitals and physician offices. This individual is responsible for front-end functions of the order fulfillment process specific to the Intake dispensing process. Individual will work with numerous insurance types in reviewing medical orders and clinical documentation to determine benefit and clinical eligibility for the LifeVest. Individual is responsible for creating and maintaining relationships with insurance companies, sales reps, and other internal departments.

Essential Functions

- Creation of patient record

- Verification of benefits

- Make dispensing decisions regarding the LifeVest based on patient-specific qualifications, documentation, and insurance carrier

- Execute all duties of the Intake dispensing process as dictated by internal process expectations and procedures

- Explain medical need and educate insurance case managers on LifeVest system to obtain authorization for services

- Identify necessary documentation needs (medical order, clinical notes, testing) and submit to insurance carriers for coverage determination

- Obtain authorizations as required by payer

- Execute timely follow up on all assigned tasks

- Maintain a score of at least Meets Expectations on monthly scorecard

- Identify qualifying diagnosis based on payer requirements

- Show demonstrated clinical aptitude related to reimbursement while maintaining a strong ability to multi-task in a stressful environment

- Exercise individual decision making in discretionary situations with little to no assistance

- Evaluate new fax documents associated with open tasks timely

- Communicate dispensing decisions containing authorization results and order status to sales representatives

- Complete fee calculator and inform billing department of appropriate charges

- Contact customers, physician offices, and sales representatives to relay and/or obtain insurance information and/or additional documentation to assist with seeking reimbursement and coordination of benefits

- Performs other duties as assigned by management

Required/Preferred Education and Experience

- High School Diploma or equivalent required

- Associate’s or Bachelor’s degree in nursing, business, or another related field preferred

- 3+ years insurance verification experience required or in