The reimbursement specialist will support the reimbursement strategy of the company by aggressively pursuing authorization and reimbursement while establishing a resource of expertise to the payors. Supports sales goals by securing authorizations and delivering the highest level of reimbursement.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Pre-screens all orders to ensure documentation is complete and warrants medical necessity.
Obtains authorization of reimbursement for the company’s products and services
Negotiates favorable pricing and payment with payors and patients where there is no current contract in place; expedites and increases shipments.
Investigates up-front denials through oral & written communication with insurance carriers.
Prepares and submits appeals on behalf of patients
Identifies referrals for in-services and preferred provider contracting.
Identifies negative trends with payors and works to resolve with key personnel.
Educates and informs sales personnel regarding Reimbursement issues in their region
Supports sales force by interfacing with patients, physicians, health insurance companies and employers to handle inquiries, troubleshoot problems, and routine follow-up calls and/or written communications
Maintains and documents complete, timely, and accurate patient billing information regarding all services rendered by the company’s products and services.
Performs on-going check and balance system to insure the integrity of the patient billing/receivables data
Escalates unresolved issues to Supervisor, Reimbursement Services
Complies with all health, safety and environmental policies, procedures and job hazard analyses applicable to specified job activities; including medical evaluations as required by job function
Completes all required HSE training
• PC experience in Microsoft Word, Excel, Outlook or other related software is essential.
• Familiarity with computer systems. Knowledge of SAP or other integrated software applications preferred.
EDUCATION and/or EXPERIENCE:
- High school diploma or G.E.D. Associates degree in business related field preferred. 4 years medical authorization experience in a medical claims environment involving negotiation, problem resolution, and order entry by using an on-line computer terminal.
- 6 plus year’s medical authorization experience in a medical claims environment involving negotiation, problem resolution and order entry using an on-line computer terminal.
- Knowledge of government program regulations, Medicare, and other third party payors.
- Must possess good written and oral communication skills with the ability to interface with customers and company personnel at all levels. Strong persuasion/negotiation skills.
- Must display professional persistence, manage detailed information; maintain high level of organization; display strong proficiency in multi-tasking by effectively managing time, projects, and priorities.