Reimbursement Specialist - Healthcare jobs in Brockton, MA

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 will be primarily responsible for managing benefit verification and prior authorization processing. This position is responsible for supporting customers throughout the reimbursement journey and ensuring access to coverage in a timely manner. Primary job responsibilities are:

• 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.

Preferred Education and Experience

• BA/BS degree in Health care Administration, Business, Economics preferred.
• 3 years of experience in reimbursement and healthcare policy, with strong knowledge of Medicare, Medicaid, managed care and private payer reimbursement process required.
• 3 years’ experience in the healthcare industry.
• 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.