Rapid Pathogen Screening, Inc. is an emerging biotechnology company. The RPS proprietary testing technologies enable the Company to develop, manufacture and market rapid, easy-to-use POC diagnostic detection tests with global application for infectious diseases and agents, inflammatory conditions, genetic markers and select chemical warfare and bio-terrorism agents.
Please visit our website: www.RPSdetectors.com for more information
The Reimbursement Director (Director) is responsible for all administrative aspects of the insurance verification, prior authorization, and denial/appeal processes for Rapid Pathogen Screenings products. The Director will respond to all provider and internal reimbursement requests in a timely fashion and is responsible for providing patient-specific coding, coverage, and reimbursement information to the company’s customers. This is a front line position in a fast paced, results driven environment and the Director must be valued by RPS customers as a consultative partner who understands and respects the physician practice environment. The Director will also work closely with the Field Sales organization, liaising with providers to problem solve denials and delayed patient reimbursement. This position requires extensive research, data compilation, analysis, plus extensive interaction with customers and payers, via phone and in person.
The Director focuses on optimizing reimbursement to RPS’s current and future products by proactively engaging with Payment Organizations/Agencies and partnering with end user practices to assure a favorable reimbursement environment. The Director is responsible for activities associated with developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for end user customers of RPS products.
The Director will develop relationships with practice managers as well as US Reimbursement and Payment Organizations/Agencies, ensuring that payment policy does not impede access to RPS products. Will support physician practice managers, serving as a liaison to ensure contracts are priced accurately; review and respond to claim disputes on behalf of physicians to verify correct pricing, and analyze claim inquiry data to determine root cause of errors; discuss/recommend and provide training as appropriate practice process improvements to maximize reimbursement success; work with both internal and external customers to identify and resolve billing and reimbursement challenges associated with RPS products, and assist RPS customers with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Additionally, the Director will review EOBs provided by end user practices and analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are being followed accurately.
The Director is responsible to provide physician practice and end user content and expertise during the Strategic Planning process regarding customer needs and insights surrounding access and reimbursement for the RPS product portfolio and emerging products. In all activities, will ensure compliance policies are maintained, and provide proactive training to sales team and external physician practice managers.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Serves as customer advocate by assisting practice managers in securing best and timely reimbursement for RPS products.
Proactively establishes relationships with practice managers and partners with them in addressing and responding to denials and appeals; follows up with payers and providers to see denied claims through to resolution.
Answers technical reimbursement and coding questions for providers, billing and coding staff, and sales representatives.
Researches customer questions as necessary and communicates with appropriate members of the team to ensure customers receive the highest level of customer service.
Prioritizes duties and tasks as necessary to ensure assignments are completed in a timely fashion.
Ensures continuous quality improvement and customer service by proactively identifying areas of improvement and communicating those ideas to the RPS management team.
Coordinates responses and resolutions to issues with appropriate internal and external parties.
Maintains and promotes positive and professional working relationships with peers and management.
Participates in reimbursement conference calls, webinars and meetings with the sales and management teams to discuss reimbursement tools, challenges, and provides insight to increasing product revenue through reimbursement strategies.
Identifies and creates reimbursement tools necessary for RPS sales and distribution teams as well as billing support tools for end-user customers.
Develops, inputs data and maintains customer reimbursement database) including coding) and verified coverage guidelines, history and research for major payers, payer decision-makers and general information on reimbursement contracts and rates.
Proposes opportunities and programs to secure EOB information for RPS’s products.
Proactively initiates the development of a program and implements processes for the insurance verification and prior authorization process for physicians, and laboratories for all company products.
Seeks and obtains product and procedure reimbursement rates and special billing rules.
Analyzes data and draws valid and logical conclusions based on information provided by insurers and/or documented medical policies.
- Pursue optimal reimbursement in discovering opportunities that would increase revenue through analyses for commercial and governmental payers.
- Conduct research and compile data to provide insight into the current Managed Care environment and monitor governmental payers and top commercial payers.
Communicates insurance verification and prior authorization results to customers and answers all related questions.
Completes all administrative responsibilities in a timely fashion.
PREFERRED EXPERIENCE AND QUALIFICATIONS
- Knowledge of Medicare, Medicaid and Private insurer reimbursement methodology.
- Prior experience obtaining patient eligibility from insurance carriers and basic understanding of the benefits investigation process [deductible, copay, coinsurance, out-of-pocket, etc.]
- Experience with the prior authorization process for products/services.
- Ability to locate, interpret and analyze detailed medical policies, EOBs, claim denials, and familiarity with the appeals process.
- Strong problem-solving, project management, and analytical skills; sense of urgency.
- Ability to perform essential duties and responsibilities with minimal supervision.
- Ability to proactively define problems, collect pertinent data, establish facts, and draw valid conclusions.
- Ability to communicate effectively and present information both orally and in writing to diverse groups (i.e. payers, providers, customers, internal sales and management teams).
- Adept at handling sensitive and confidential situations.
- Exceptional interpersonal skills.
- Strong organizational skills; attention to detail.
- Ability to represent a positive and professional image.
- Ability to create and maintain databases.
- Proficiency of Microsoft Word, Excel, PowerPoint and Outlook.
- Four year college degree and 3 years prior reimbursement, coding or billing experience with diagnostics within a company and previous physician offices or clinical laboratories experiences is preferred. With undergraduate degree, five years of recent relevant experience.
- CPC certification.
- Experience in a reimbursement-based call center environment.