Venture Medical, LLC Insurance Verification and Reimbursement Specialist Remote · Full time Company website

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Established in 2009, Venture Medical, LLC has pioneered novel solutions in wound care including biofilm management, imaging, diagnostics, and biologic allografts, while expanding access to therapies in multiple care environments. Venture Medical’s motto is “Be Bold, Be Prepared, Lead Change,” and is committed to doing business in an ethical manner, focusing on the needs of patients, providers, and their staff. We are proud to be based in Missoula, Montana.

POSITION TITLE: Insurance Verification (IVR) and Reimbursement Specialist

LOCATION: Missoula, MT preferred – Remote considered in states in which Venture Medical, LLC is registered as an employer

FLSA STATUS: Non-Exempt

Reports to Senior Reimbursement Manager; dotted line to Senior Billing Manager.

CHARACTERISTICS OF THE POSITION:

The IVR and Reimbursement Specialist executes the frontline reimbursement work that keeps cases moving through Venture Medical, LLC's wound care and Durable Medical Equipment (DME) pipelines. This role performs insurance eligibility verification, initiates authorizations, follows up on appeals and open case items, and prepares documentation-ready claims for review by the billing team. The position works across surgical and disposable wound care dressings, compression, and advanced wound care modalities — including PRP, skin substitutes, and low frequency ultrasound therapy — and serves as the first point of case progression, escalating complex reimbursement determinations to the Senior Reimbursement Manager and complex billing or coding questions to the Senior Billing Manager.

ESSENTIAL DUTIES:

•         Perform insurance eligibility verification for surgical and disposable wound care dressings, compression garments and supplies, and advanced wound care modalities (PRP, skin substitutes, low frequency ultrasound therapy and related products) across Medicare, Medicare Advantage, Medicaid, and commercial payers.

•         Initiate prior authorization and medical authorization requests; track and update authorization status in CRM and Venture OneView through to final determination.

•         Follow up on submitted appeals and outstanding case items; monitor timelines against payer and internal SLAs, and escalate stalled or at-risk cases to the Senior Reimbursement Manager.

•         Manage outstanding customer action items — outreach to patients, providers, and representatives for missing documentation, signatures, or clarifications needed to move a case forward.

•         Review clinical and administrative documentation (physician notes, wound measurements, orders, and LCD/NCD-required elements) for completeness and payer-specific sufficiency ahead of claim preparation. This review is administrative only. The position does not exercise clinical judgment; create, alter, complete, or supplement clinical documentation; or advise treating providers regarding the clinical content of their records.

•         Prepare documentation packages and claims for review by the Senior Billing Manager or billing team — assembling and validating supporting documentation, confirming authorization and eligibility status, and flagging documentation gaps before handoff.

•         Maintain accurate, timely records of eligibility, authorization, and appeal status in the CRM, Venture OneView, and other Venture systems of record.

•         Communicate professionally with payers, providers, and internal teams to resolve eligibility and authorization questions.

•         Escalate complex reimbursement determinations to the Senior Reimbursement Manager and complex billing, coding, or claims questions to the Senior Billing Manager.

•         Maintain accurate, complete, and compliant documentation in accordance with HIPAA and company policy.

•         Plan and organize daily workload to meet productivity expectations and SLA requirements.

•         Report suspected billing, coding, documentation, or other compliance concerns in accordance with Venture Medical, LLC’s Compliance Program and Code of Conduct. Venture Medical, LLC does not retaliate against any employee for making a good-faith report.

•         Other duties as assigned.

RELATED DUTIES:

•         Assist with data analysis and reporting on eligibility, authorization, and appeal trends.

•         Support updates to training materials for IVR and eligibility workflows as processes evolve.

MINIMUM QUALIFICATIONS:

Training and Experience

•         One or more years of experience in insurance verification, prior authorization, medical billing, or healthcare administration.

•         Experience in wound care, DME, medical devices, or specialty care preferred but not required.

•         Experience with CRM or practice management platforms required.

•         HIPAA compliance knowledge required.

Knowledge, Abilities and Skills

•         Working knowledge of commercial insurance, Medicare/Medicaid, prior authorization requirements, and medical terminology.

•         Familiarity with LCD/NCD-driven documentation requirements a plus.

•         Detail-oriented with strong documentation-review skills; able to spot missing or insufficient claim documentation before it reaches billing.

•         Strong verbal and written communication skills; comfortable handling high-volume payer calls.

•         Strong organizational skills with the ability to manage multiple concurrent cases against SLA and filing deadlines.

•         Comfortable learning new digital platforms quickly (e.g., CRM, Venture OneView).

•         Ability to work independently and collaboratively in a fast-paced environment.

PHYSICAL REQUIREMENTS:

•         Prolonged periods of sitting and working at a computer.

•         Occasional lifting of up to 10 pounds.

•         Manual dexterity for keyboarding and telephone use.

•         Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.

Working Conditions

•         Office environment with a collaborative and dynamic team atmosphere.

•         Hybrid or remote working arrangements may be considered depending on business needs.

•         Minimal travel may be required for training or team meetings.

•         This is a non-exempt position. All hours worked must be recorded accurately and completely, and overtime must be approved in advance by the Senior Reimbursement Manager.

This job description describes the general nature and level of work performed and is not an exhaustive list of all duties, responsibilities, or requirements. It is not an employment contract and does not alter the at-will employment relationship between the employee and Venture Medical, LLC. Venture Medical, LLC reserves the right to modify this position and its duties at any time. The employee’s signature below acknowledges receipt and review of this job description only.

Venture Medical, LLC, is committed to diversity and inclusion in the workplace. Individuals seeking employment at Venture Medical, LLC, are considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, ancestry, disability, veteran status, or other legally protected characteristics. Reasonable accommodations available.