ZOLL LifeVest, a Pittsburgh-based subsidiary of ZOLL Medical Corporation, develops, manufactures and markets a wearable defibrillator for persons with Sudden Cardiac Arrest (SCA) risk in the United States and Europe. The LifeVest is worn by patients at risk for sudden cardiac arrest (SCA), providing protection during their changing condition and while permanent SCA risk has not been established. The LifeVest allows a patient’s physician time to assess their long-term arrhythmic risk and make appropriate plans. The LifeVest is lightweight and easy to wear, allowing patients to return to their activities of daily living, while having the peace of mind that they are protected from SCA. The LifeVest continuously monitors the patient’s heart and, if a life-threatening heart rhythm is detected, the device delivers a treatment shock to restore normal heart rhythm.
The LifeVest is used for a wide range of patient conditions or situations, including following a heart attack, before or after bypass surgery or stent placement, as well as for those with cardiomyopathy or congestive heart failure that places them at particular risk. The LifeVest is covered by most health plans in the United States, including commercial, state, and federal plans.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- The Intake Specialist is an integral member of the reimbursement team and has primary responsibility for the timely clearance of new referrals (medical orders) from Lifecor field sales representatives and physician offices.
- This position is also responsible for billing the initial claim to the primary (and secondary, if applicable) insurance carrier for payment, along with the creation of the patient chart.
- Additional responsibilities include the submission of and participation in telephone hearings and ALJ appeals for all Medicare denials.
- Contact insurance companies to verify benefits for services and communicate results to patient and sales.
- Communicate medical need and educate case manager on LifeVest system to obtain authorization for services.
- Negotiate favorable rates with insurance carriers with guarantee of assignment of benefits, and complete fee calculator for billing.
- Obtain necessary documentation (medical order, clinical notes, patient agreement, etc.), determine medical criteria eligibility, and submit to insurance carrier for coverage determination.
- Assist team members with clinical interpretation of patient’s record during re-authorization process.
- Contact client, physician office, and sales representative to relay and/or obtain pertinent information and/or documents to effect clearance of new referrals.
- Create patient record in SoftAid; create reimbursement chart; create initial claim and submit to insurance carrier.
- May need to assist in maintaining spreadsheet of hearings and ALJ requests; submit request along with supporting documentation to CMS; track requests; follow-up with CMS on requests that have not been scheduled; prepare files for hearings and ALJ meetings, and participate in those meetings.
This job has no supervisory responsibilities.