Provider Benefit Verification Specialist II (Reimbursement Specialist)

Canton, MA

Job Req code: 718

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.

                                                                      We are invested in your career!  

 

The Provider Benefit Verification Specialist II is part of the Reimbursement team. The hours for this position are Monday - Friday from 9:30am - 6:00pm.

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 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

Preferred Education and Experience 

  • BA/BS degree in Health care Administration, Business, Economics preferred
  • 6 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

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.