Cardiac EVA Specialist

JOB DESCRIPTION

At ROMTech we are transforming recovery through innovative technology data-driven care and exceptional service. We are committed to improving outcomes by delivering high-quality solutions that support patients providers investors and business partners while fostering a culture of collaboration accountability and continuous improvement.

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology infrastructure and first mover position to enter cardiology followed by other adjacent markets. Having created this new lane we have a unique opportunity to serve as the global leader in the business technology and science of recovery and to bring life-changing help to many millions of people.

Position Title: Eligibility and Prior Authorization (EVA) Specialist - RCM
Department: Revenue Cycle Management (RCM)
Reports To: EVA Manager
Location / Work Environment: Clearwater FL Office Environment
FLSA Status: Non-Exempt
Job Level: Standard

The Eligibility and Prior Authorization (EVA) Specialist is responsible for ensuring accurate and timely insurance eligibility verification benefits investigation prior authorization processing referral validation and related revenue cycle activities that support ROMTechs reimbursement and patient service objectives. This role serves as a critical front-end revenue cycle function by confirming coverage requirements obtaining required authorizations maintaining payer compliance and facilitating seamless coordination among internal teams providers patients and payers. The EVA Specialist contributes to operational efficiency reimbursement integrity denial prevention and positive patient experiences through accurate documentation proactive problem solving and adherence to regulatory and payer requirements.

• Verify and validate patient demographic information including name address date of birth insurance information and other required registration data.
• Verify patient insurance eligibility coverage benefits limitations and financial responsibility requirements.
• Obtain review and confirm referrals authorizations certifications and payer approvals as required.
• Process and document insurance verification and authorization activities accurately and within established timelines.
• Ensure compliance with HIPAA CMS Medicare Medicaid OIG payer requirements and applicable state and federal regulations.
• Support accurate assignment and validation of CPT HCPCS and ICD-10-CM codes consistent with established processes and payer requirements.
• Review documentation to ensure services meet medical necessity and payer coverage requirements.
• Obtain single case agreements and payer exceptions when necessary to support reimbursement activities.
• Collaborate with clinical intake customer service billing sales and operational teams to obtain missing incomplete or unclear documentation.
• Research and resolve authorization issues payer discrepancies claim rejections and eligibility-related denials.
• Maintain accurate records within applicable systems and databases.
• Follow established workflows and performance standards to support revenue cycle objectives.
• Utilize healthcare technology platforms and business systems to perform verification authorization and documentation functions efficiently.
• Support departmental quality assurance efforts through accurate recordkeeping and process adherence.
• Maintain confidentiality of patient payer and company information at all times.

• Assist with billing-related projects and departmental initiatives as needed.
• Participate in training cross-functional projects and process improvement activities.
• Support audits reporting requests and compliance reviews.
• Maintain knowledge of payer policies coverage updates and reimbursement requirements.
• Performs other related duties as assigned to support operational and business needs.

JOB QUALIFICATIONS

• Strong attention to detail and accuracy.
• Excellent organizational and time management skills.
• Ability to multitask and manage competing priorities in a fast-paced environment.
• Strong verbal and written communication skills.
• Ability to work collaboratively across departments.
• Knowledge of insurance eligibility verification and authorization processes.
• Proficiency with Microsoft 365 applications.
• Ability to learn and navigate multiple software systems simultaneously.
• Strong problem-solving and critical-thinking abilities.
• Ability to maintain confidentiality and comply with applicable regulations and company policies.

• Knowledge of orthopedic DME RTM cardiology and healthcare reimbursement processes.
• Familiarity with Brightree AdvancedMD RingCentral Slack Zooper iOMS Paycom PandaDoc ServiceNow or similar platforms.
• Typing proficiency of approximately 60-70 words per minute.
• Knowledge of denial prevention and resolution strategies.

• Experience in insurance verification prior authorization revenue cycle management medical billing healthcare administration or a related healthcare support function.
• Experience working with payer guidelines eligibility verification and insurance documentation processes.

• One to three years of recent experience in revenue cycle management insurance verification prior authorization or related healthcare operations roles.
• Experience supporting remote therapy monitoring rehabilitation services DME orthopedics or cardiology reimbursement functions.
• Understanding of the full revenue cycle process including registration verification charge capture coding billing collections and payment posting.

• High school diploma or equivalent.
• Associate degree in Healthcare Administration Medical Billing and Coding Business Administration or a related field.

• Certified Professional Coder (CPC) Certified Revenue Cycle Representative (CRCR) Certified Medical Reimbursement Specialist (CMRS) or similar healthcare revenue cycle certification.

Physical Demands and Working Conditions

The following describes the physical demands and work environment characteristics required to perform the essential functions of this position. These requirements are representative of those an employee may encounter while performing thejoband are not intended to be an exhaustive list. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.

• Ability to sit at a computer terminal for an extended period.

• Moderate noise (i.e. phone calls online meetings computer audio)

• While performing the duties of thisjob the employee may be regularly required to stand sit talk hear reach stoop kneel and use hands and fingers to operate a computer telephone and keyboard.

• Specific vision abilities required by thisjobinclude close vision requirements due to computer work.

• Regular predictable attendance is required.

• Must be able to communicate clearly and professionally in both verbal and written formats.

• Must be able to engage in active listening and express ideas effectively in person by phone and via virtual meetings.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of thisjob. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reasonable accommodation requests must be made in writing by emailing.