Provider Benefit Verification Specialist II

12495 34th Street North, St. Petersburg, Florida, 33716, United States

Job Req code 405

Category: Reimbursement

About Us

We are a leading regenerative medicine company in the advanced and acute wound care space and are always looking for exceptional talent. Join a company where you will have an opportunity to grow professionally and personally and give strength to others by Empowering Healing. Our advanced wound care products are specially developed for the successful treatment of chronic and acute wounds. Our comprehensive portfolio of skin substitutes and other regenerative medicine products empower our patients with life-changing solutions.  Our strength is giving others strength.

Learn more about Careers at Organogenesis


What You Will Achieve:

The St. Petersburg, FL office is looking for a dynamic and detailed oriented Provider Benefit Verification Specialist II to join the team! In this position, the Provider Benefit Verification Specialist will provide billing and reimbursement support to sales specialist and customers. This position reports to the Manager of Reimbursement. 


How You Will Achieve It:

  • Investigate patient’s medical benefits and identify opportunities for prior authorizations.
  • Prepare and submit prior authorizations in a timely manner.
  • Effectively interface with hospitals, wound care centers and physicians to ensure the highest level of reimbursement is attained.
  • Communicate and accurately document payer trends.
  • Foster partnerships with national accounts.
  • Monitor and update Medicare, Medicaid and private payer policies and guidelines.
  • Monitor and communicate policy developments that impact the reimbursement success of products.
  • Help build relationships in key markets with government, physician, hospital, and third-party payer decision makers.
  • Demonstrate a strong understanding of payer policies and how to leverage this knowledge to support the benefit verification process
  • Understand and utilize reimbursement tools to minimize customer inquiries.
  • Ability to meet strict metrics for quota and turn-around time 
  • 16-22 Reimbursement cases completed consistently
  • Comply with all company policies and procedures 
  • Other duties as needed.


Other Skills/Abilities

  • Polished and professional presence and phone manner.
  • Excellent customer service skills.


What You Need to Achieve It:

  • High school diploma or equivalent required. BA/BS degree in Healthcare Administration, Business, Economics preferred.
  • 3 years’ experience working in Healthcare reimbursement required.
  • Functional expertise in reimbursement and healthcare policy, with strong knowledge of Medicare, Medicaid, managed care and private payer reimbursement process required.
  • Medical device or biologics experience preferred.
  • Ability to communicate in a professional manner with providers, insurances, and internal customers and colleagues required.


Physical Activities

  • Remaining in a sitting position for long periods of time.
  • Repeating motions that may include the wrists, hands, and/or fingers.


Environmental Conditions

  • Working indoors
  • No adverse environmental conditions


What can we offer you:

  • 401k -- generous employer match with immediate vesting and financial planning resources
  • Comprehensive Medical, Dental and Vision coverage options effective on day one of employment
  • Flexible Spending Account (medical expenses or dependent care expenses) or Health Savings Account
  • Company paid insurances including Short Term, Long Term and Life insurances as well as voluntary options
  • Paid maternity leave and parental leave for all new parents
  • Adoption benefits
  • Education Assistance Policy - $5,000 per year for all employees
  • Wellness Program including free trainings on mental health, mindfulness, stress reduction, on-site flu shots and more
  • Employee Assistance Program
  • Generous paid time off including vacation, floating holidays, sick days, and company holidays
  • Free parking including an electric charging station (Canton and La Jolla)
  • Discounts at BJs Wholesale, Dell, Sullivan Tire, and Sprint


We are an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, genetic information or any other characteristic protected by law.