Provider Benefit Verification Specialist III

85 Dan Road, Canton, Massachusetts, 02021, United States

Job Req code 539

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 Provider Benefit Verification Specialist III is part of the Reimbursement team and assists with the reimbursement process.. This position helps with patient assistance programs, coverage verification, information on ordering and shipping, and details on coding. From the moment our products are deemed appropriate for patients, through treatment, we're with the customer every step of the way. The hours for this position are Monday - Friday from 9amEST - 5:30pmEST or 9:30amEST - 6pmEST. Training will be on-site (two to three months) with a hybrid work schedule after training is complete (in office one day a week.) The ideal candidate will be located in Canton, MA or nearby. This position reports to the Supervisor 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 
  • Complete 16-22 Reimbursement cases, 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

Requirements

What You Need to Achieve It:

  • BA/BS degree in Health care Administration, Business, Economics preferred
  • 5 years’ experience in the healthcare industry
  • 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

 

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

 

Environmental Conditions

  • Working indoors
  • No adverse environmental conditions

 

Physical Demands

  • Sedentary Work - exerting up to 10 pounds of force occasionally or an amount of force frequently to lift, carry, push, pull, or otherwise move objects. Sedentary work involves primarily sitting most of the time.
  • Remaining in a sitting position for long periods of time.
  • Repeating motions that may include the wrists, hands, and/or fingers.

 

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.