Provider Benefit Verification Specialist

Canton, MA

Job Req code: 681

Category: Customer Service

We have unique opportunities 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.

Organogenesis corporate headquarters is located in Canton, Massachusetts, and we have an additional site in Norwood, Massachusetts. Our Canton location is the manufacturing site for PuraPly® AM (which heals acute and chronic wounds), and Apligraf® (for the treatment of surgical wounds). Our Norwood location manufactures ReNu® (offering regenerative and anti-inflammatory properties to create an environment that reduces pain) and NuCel® (which provides an enhanced environment for tissue growth, repair and healing). Canton is also the location for Customer Service, Reimbursement and other corporate teams, supporting our full range of products.

The hours for this position are Monday - Friday, 9:30am-6:00pm.

Key Responsibilities

  • 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 insure 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.
  • Other duties as needed.

Requirements

Preferred Education and Experience

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Associate's degree preferred. Equivalent experience will be accepted in lieu of degree.
  • 3+ years of work experience in the healthcare industry preferred.
  • Functional expertise in reimbursement and healthcare policy, with strong knowledge of Medicare, Medicaid, managed care and private payer reimbursement process required.
  • Polished and professional presence and phone manner, and excellent customer service skills 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

 

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.