Provider Benefit Verification Specialist (Reimbursement Specialist)

Canton, MA

Job Req code: 681

Category: Reimbursement

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. We offer a strong benefits package, opportunities for growth, and the chance to contribute to our mission: to provide an integrated portfolio of healing solutions that improve lives while lowering the overall cost of health care.

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.


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.