Team Lead, Reimbursement

Canton, MA

Job Req code: 722

Category: Reimbursement

Organogenesis corporate headquarters is located in Canton, Massachusetts, including manufacturing, R&D, customer service, reimbursement and other corporate teams supporting our full range of products. 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.

The Team Lead reports to the Reimbursement Supervisor and works Monday - Friday from 9:30am-6:00pm.

JOB RESPONSIBILITIES: 

  • Investigate patients' medical benefits and identify opportunities for prior authorizations 
  • Monitor performance of others and assist with team training
  • Exercise considerable latitude in setting functional priorities and assigning resources accordingly
  • 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 Pay or 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 
  • Consistently complete 20-24 reimbursement cases
  • Train new hire team members
  • Assist with call monitoring
  • Lead conference calls independently
  • Participate in training of sales representatives including role play and shadow training
  • Utilize technology and resources available to reimbursement team to minimize calls to the provider
  • Consistently achieve 100% accuracy on audits and coach team members to enable them to achieve this goal
  • Consistently produce the highest quality of work 
  • Demonstrate a strong understanding of payer policies and how to leverage this knowledge and support the business
  • Cultivate a strong working relationship and exchange information with key opinion leaders in medical practices, internal customers, professional medical organizations and affiliated industry groups
  • Effectively analyzes complex reimbursement data and make appropriate recommendations 
  • Seek and accept challenging tasks to learn and develop competencies
  • Deliver World Class Service to all internal and external customers
  • Look for ways to reduce errors and lower costs
  • Follow all reimbursement internal processes
  • Effectively handle and resolve conflicts
  • Other duties as needed 

Requirements

Preferred Education and Experience:

  • BA/BS degree in Health Care Administration, Business, Economics, or related area strongly preferred
  • 9+ years' work experience in the health care industry
  • Functional expertise in reimbursement and health care policy required
  • Intimate knowledge of Medicare, Medicaid, Managed Care and Private Payor reimbursement process required
  • Ability to provide benefit verification and prior authorization status updates to providers accurately and in a timely manner required
  • Ability to communicate in a professional manner with providers, insurances, and internal customers and colleagues required
  • Self-disciplined and Independent individual with the ability to self-motivate in a work from home environment
  • Medical device or biologics experience preferred 

 

Other Skills/Abilities:

  • Must be confident in presentation skills and ability to educate customers
  • Polished and highly professional presence in person and on phone
  • Excellent customer service and verbal communication skills
  • Excellent presentation skills

 

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 Demand:

  • 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.