Field Reimbursement Manager

At MIMEDX, our purpose starts with helping patients heal. We are driven by discovering and developing regenerative biologics utilizing human placental tissue to provide breakthrough therapies addressing the unmet medical needs for patients across multiple areas of healthcare. Possessing a strong portfolio of industry leading advanced wound care products combined with a promising clinical pipeline, we are committed to making a transformative impact on the lives of patients we serve globally.

POSITION SUMMARY:

Provide reimbursement education to provider accounts on the coding and billing of claims, insurance verification process, and reimbursement reviews after claims are adjudicated.  Support an assigned regional sales team as it relates to managing provider accounts.  Will be required to travel to build strong relationships with provider accounts and their staff. The position follows all necessary policies, procedures, processes and systems in place in a field based support position.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Conduct training and education for new and existing provider accounts on Insurance Verification Request (IVR) process, and billing and coding of claims
• Monitor accounts to ensure proper payment of claims, identify any reimbursement issues, and work with the account to resolve, following standard operating procedures
• Communicate billing procedures (including coding procedures and processes for denial and low payment appeals) to physician, hospital, outpatient facility/ambulatory surgical center, and ensure timely filing of claims and appeals
• Conduct claim reimbursement reviews to monitor payments and collections data; provide detailed analysis and identify billing errors
• Investigate all denied or partially paid services and provide guidance regarding next steps and support needs
• Work as liaison with provider accounts, and the sales and reimbursement teams to provide information required to timely complete IVR cases
• Adhere to HIPAA policies and procedures to ensure compliance
• Adhere to the organization’s appeal strategy and manage its on-going tactical application to ensure a successful reversal rate
• Report changes in coverage/reimbursement trends and global concerns in this area to management to ensure corrective actions and mitigation of future occurrences
• Troubleshoot national and local payer reimbursement issues

PROBLEM SOLVING:

• Performs full range of standard professional level work that typically requires processing and interpreting, more complex, less clearly defined issues. Identifies problems and possible solutions and takes appropriate action to resolve.
• Demonstrates skill in data analysis techniques by resolving missing/incomplete information, inconsistencies/anomalies in more complex research/data.

DECISION MAKING/SCOPE OF AUTHORITY:

• Nature of work requires increasing independence; receives guidance only on unusual complex problems or issues.
• Work review typically involves periodic review of output by supervisor and/or direct "customers" of the process.

SPAN OF CONTROL/COMPLEXITY:

• Fully competent and productive professional contributor, working independently on larger, moderately complex projects/assignments that have direct impact on department results

EDUCATION/EXPERIENCE:

• BS/BA in related discipline
• 2-5 years of experience in related field with 1-3 years of progressive responsible positions, or verifiable ability

OR

• MS/MA and 1-3 years of experience in related field. Certification is required in some areas
• Experience in insurance verification, appeals negotiations and processing, billing/claims processing, data processing, and software operations in the health care industry; preferably in the wound care industry
• Prefer sales or account management experience
• Strong understanding of Medicare, Commercial and Medicaid health plans
• Strong understanding of medical coding including ICD10, CPT and HCPCS codes

Strong understanding of medical management and health insurance concepts, information systems and strong analytical and problem solving skills

SKILLS/COMPETENCIES:

• Excellent oral, written, and interpersonal communication skills
• Ability to interact with all levels of management, both internal and external, third party payers, and customers
• Proficient in Microsoft Office (Excel, Word)
• Organized, flexible, and able to multi-task while maintaining a high level of efficiency and attention to detail
• Strong analytical skills, clinical interests, strategic and technical analysis and problem solving skills
• Ability to influence others to achieve desired results using tenacity and diplomacy

WORK ENVIRONMENT:

The work is typically performed in a normal office environment.  Will be required to travel 2-3 days a week to build solid account relationships (50% to 75% of time).

 Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to, or requirements for, this job at any time.