Provider Benefit Verification Specialist III

White Plains, NY

Job ID: 626

Job Req code: 626

Category: Customer Service

Job Type: Reimbursement

Organogenesis is a leading regenerative medicine company focused on empowering healing through the development, manufacturing and sale of products for the advanced wound care, surgical and sports medicine markets. Our mission is to provide an integrated portfolio of healing solutions that improve lives while lowering the overall cost of health care. We are relentless in the pursuit of quality and innovations that make all the difference. We are seeking a Provider Benefit Verification Specialist to join our Reimbursement team.

KEY RESPONSIBILITIES 
Investigate patient’s medical benefits and identify opportunities for prior authorizations. 
Prepare and submit prior authorizations in a timely manner and follow-up on status.  
Effectively interface with hospitals, wound care centers and physicians to insure the highest level of reimbursement is attained. 
Communicate and accurately document pay or trends. 
Foster partnerships with provider sites. 
Communicate policy developments to Organogenesis Reimbursement Management that impact the reimbursement Organogenesis products.  
Build relationships with physician, hospital, and third-party payer decision makers. 
Consistently complete an average of 18-22 BVs daily  
Participate in conference calls approved by Organogenesis Management regarding cases worked or in process
Appropriate use and understanding of Reimbursement tools and materials to minimize calls to the provider
Demonstrate a strong understanding of payer policies and how to leverage this knowledge to support the Benefit Verification Process
Cultivates a strong working relationship and exchange information with key opinion leaders in medical practices, internal customers, professional medical organizations and affiliated industry groups
Ability to provide Benefit Verification and Prior Authorization status updates to providers timely and accurately  
Provide world class service to all internal and external customer
Effectively handles and resolves conflicts
Ability to communicate in a professional manner with providers, insurances, and internal customers and colleagues
Update Reimbursement Management immediately when potential issues arise
Comply with all company policies and procedures 
Other duties as needed

Requirements

Job Requirements: 
BA/BS degree in Health Care Administration, Business, Economics. 
9+ years of work experience in the health care industry. 
Medical device or biologics experience preferred. 
Functional expertise in reimbursement and health care policy is necessary. 
Must possess an intimate knowledge of Medicare, Medicaid, Managed Care and Private Payor reimbursement process.