Provider Reimbursement Liaison - FL

Home Based Telecommute - US,

Job Req code: 843

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. 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.

Key Responsibilities:

  • Obtain benefit verification or opportunities for prior authorizations based on patient’s insurance coverage. 
  • Prepare and submit prior authorizations in a timely manner and follow up on status  
  • Effectively interface with hospitals, wound care centers and physicians to ensure the highest level of reimbursement is attained 
  • Communicate and accurately document payor trends 
  • 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 20-25 benefits verifications (BVs) daily  
  • Participate in calls approved by Management regarding cases, inquires or other related topics
  • Understand and utilize reimbursement tools to minimize customer inquiries.
  • Demonstrate a strong understanding of payer policies and how to leverage this knowledge to support the benefit verification process
  • Creation of presentations and the ability to present to all levels of an organization
  • Onsite visits with customers and participation in sales meetings as needed
  • Cultivate a strong working relationship and exchange information with key opinion leaders in medical practices, internal customers, professional medical organizations and affiliated industry groups
  • Provide world class service to all internal and external customers
  • Effectively handles and resolves conflicts
  • Update reimbursement management immediately when potential issues arise
  • Comply with all company policies and procedures 
  • Ability to meet strict metrics for quota and turn-around time
  • Up to 25% travel required 
  • Other duties as needed


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:

  • Polished and professional presence and phone manner.
  • Excellent customer service and verbal communication skills.
  • Effective 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.