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Reimbursement Specialist - St. Louis or Kansas City
The Field based Reimbursement Specialist is a critical front-line member of the Reimbursement Operations team. The primary purpose of this role is to support the customers in obtaining appropriate reimbursement and to support the company and department reimbursement strategy for the Regenerative Medicine products.
This is a field based position, and the candidate can be based in St. Louise or Kansas City. The territory will be the Plains Region.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1.Provide appropriate coding and billing guidance
•Establish relationships with sales representatives and customers to provide reimbursement service in an appropriate, prescribed manner.
•Reimbursement educational activities w/sales representatives, prospective and new customers to understand potential for coding and coverage decisions to support expected reimbursement outcomes. Make strategic consultative calls and meet with accounts to handle reimbursement questions regarding the coding, coverage and reimbursement for company products. This assistance can be provided to accounts via phone/FAX communication or on-site visits with more complex cases.
•Assist customers in analyzing claims and advise on appeals within the scope of FDA labeling and the intended product utilization. Investigate all denied or partially paid services with customers and Reimbursement Hotline and provide follow-up to Reimbursement Department Manager, sales representative, and customer as appropriate regarding next steps and support needs.
•Must be adaptable to anticipate customer needs, as well as overall reimbursement requirements as determined by the strategic direction w/in the department and as required by government and non-government payers.
2. Additional Responsibilities
•Provide reimbursement support via distribution of reimbursement materials and assistance to customers and sales representatives.
•Work with Reimbursement Manager to track and report on trends within territory.
•Assist hotline staff in addressing coding, coverage or reimbursement resolutions, appeals for authorization and payment as directed.
•Work collaboratively with the aligned Regional Sales Directors to facilitate the overall reimbursement goals and objectives. Work cooperatively within a team-focused organization. (Work closely with sales and sales management to ensure external customers are educated on reimbursement opportunities).
•Ability to present effectively and communicate desired information at POA’s, Lunch and Learns and in the field based account call setting w/customers.
•Develop strategies to resolve reimbursement issues and maximize product utilization.
•Investigate and respond to questions regarding billing and coding issues, participate in the claims and EOB review process.
•The ability to mentor new RS’s as demonstrated by training, shadowing, troubleshooting, etc.
•Demonstrated initiative and leadership skills w/in the territory by feedback provided by customer or sales reps.
•CPC or CPC- H cert. preferred.
•Must live in geographical area which the territory covers. Travel is 50% to 75% with some overnight travel.
•Previous experience presenting coverage, coding and payment material in front of large “high level educated” groups (25 people and above).
•Responsible for submitting individual development goals, territory business plan, expense reports and other reports as requested by the Director of Reimbursement Operations and/or Reimbursement Manager in a timely fashion.
Complete assignments/projects as directed and in a timely manner.
•Demonstrate appropriate territory planning and time management skills by effectively covering the specific geographical area of responsibility.
•Successfully complete site visit and/or lunch and learn reimbursement education presentations.
•Must be proficient with cost effective management of assigned expense budget.
EDUCATION and/or EXPERIENCE
Bachelor's degree from a four-year college or university.
2-8 years healthcare coding, coverage and reimbursement experience with device, pharmaceutical and/or biotechnology manufacturer. Outside sales experience is helpful in this role.
Specific experience/ skills needed include the following:
•Previous experience working w/ billing and medical claims personnel in various health care settings including, but not limited to a physician office, outpatient hospital setting and ambulatory surgery center.
•Proven expertise in medical coding, billing processes and claim submissions to public and private insurers for biotechnology products, medical devices and pharmaceuticals. Also maintain familiarity with appropriate coding terminology and processes [CPT, HCPCS, ICD-9, revenue codes and DRG], coverage and reimbursement.
•Ability to review health insurance forms including UB-04, CMS-1500, explanation of benefits, and prior authorization forms, as well as provider encounter forms [superbills/charge tickets] to troubleshoot cases where billing, claims submission or documentation errors may occur.
Base + bonus, budget, full benefits, 401K, etc.
Leading company involved in regenerative medicine within wound care.
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