Reimbursement Specialist

• Role Overview:
  
  This role will support the company in achieving its mission to connect patients, providers, and payors to ensure patients can access best-in-class technologies and products. The Reimbursement Specialist is responsible for verifying patient benefits for incoming insurance verification requests, responding to verification related inquiries, and reporting patient coverage based on payer coverage criteria and reimbursement information to the requesting healthcare provider. The Reimbursement Specialist will be responsible for data quality/integrity and appropriately document all interactions related to the benefit investigation into a dedicated database. The Reimbursement Specialist will also be responsible to provide best in class customer service support for all outbound provider communication, inbound calls, and may include case escalations as appropriate. The Reimbursement Specialist will be required to follow company policies, procedures, and compliance directives at all times. This role will be required to ensure all protected health information (PHI) is managed appropriately within the governing Health Insurance Portability and Accountability Act (HIPAA) guidelines.
  
  Responsibilities: (Please specify % amount against each responsibility)
• (30%) Performs a detailed insurance benefit verification for all products including obtaining patient responsibility, researching payer coverage criteria, and any required prior authorization requirements.
• (30%) Maintain clear documentation of all tasks, review reports for accuracy and completeness, prepare and send insurance benefit verification results to healthcare providers, and protect PHI, all within the departments directed time allotment.
• (20%) Reports any payer delays/ reporting challenges and escalates complaints accordingly to Team Lead and/or Supervisor as necessary.
• (10%) Collaborates with Market Access and Field Reimbursement teams to further investigate reporting issues or change in payer coverage criteria.
• (10%) Performs related duties as assigned.
• Location:
  
  Remote
  
  Education:
  
  Required
• Work experience or education in a healthcare related, life sciences, or quantitative field (Medicine, Nursing, Biology, Biochemistry, Engineering, Math, Finance/Accounting, or related)
• Preferred
• Four year college degree
• Reimbursement and/or Healthcare admissions/Intake experience within the healthcare industry
• Experience:
  
  Required
• 2 or more years of customer service, healthcare admissions/intake, and/or reimbursement experience within the biotechnology, pharmaceutical or Durable Medical Equipment (DME) industry, or related field
• Basic knowledge of Medicare, Medicaid, and Private Insurance Reimbursement Methodology
• Able to interpret and analyze detailed medical policies and coverage criteria
• Understanding of the patient's benefits verification process including health plan benefit structure (coverage, deductible, out of pocket, benefits exclusions, etc.)
• Preferred
• Prior experience working for a medical or pharmaceutical reimbursement hub or hotline
• Previous coding and billing experience in the healthcare industry - preferred, but not required
• Intermediate knowledge of Microsoft based products/Office Suite (Word, Excel, Outlook, Skype, TEAMS, etc.)
• Basic understanding of Data Entry/Customer Relationship Management programs (SalesForce, Dynamics365, other)
• Familiar with ICD 10 Coding
• Competences:
• Exceptional Customer Service skills that align with Smith and Nephews best in class culture
• Strong attention to quality and details in adherence to standards while ethically maintaining a business perspective
• Strong work ethics and holds self-accountable with willingness to learn, and desire to continually improve
• Ability to consistently interact professionally at multiple levels within a client-oriented organization
• Possesses effective communication skills, oral, written, listening, and non-verbal
• Excellent organizational and time management skills
• Travel Requirements: Up to 10%
  
  Physical Demands:
• Employee is regularly required to stand, sit, talk, hear/listen, and use hands and fingers to operate a computer and telephone keyboard
• Close vision requirements due to computer work
• Light to moderate lifting required, example: Using the in-office printer and refilling paper trays/toner
• Displays strong critical thinking skills
• Flexibility and adaptability to change according to business needs
• Able to handle high volume case situations and maintain a positive attitude in a fast-paced environment

Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.