Reimbursement Specialist

Do you have a passion for working with people in the healthcare setting? Do you want to have an impact on scientific advancements in the medical field? If so, we are looking for someone like you to join our Reimbursement Hotline Team.

About Smith & Nephew

Smith & Nephew is committed to helping people regain their lives by repairing and healing the human body. At Smith & Nephew you will have the opportunity to make a tangible difference to people's lives. Globally recognized as a Great Place to Work, Smith & Nephew embodies a purpose-driven culture of Care, Collaboration and Courage.

What you'll be doing:

The Reimbursement Specialist (RS) is responsible for various reimbursement functions, including but not limited to Intake, Data Entry, Benefit Investigations, and Call Triage. This is a front line position in a fast paced, results driven environment. The Reimbursement Specialist (RS) responds to all provider, patient, and internal requests in a timely fashion and is responsible for providing patient specific coding, coverage, and reimbursement information to the hotline's customers.

• Acts as single point of contact and voice for all providers, patients and product / sales team.
• Initiates and coordinates the insurance verification for physicians, hospitals, and ambulatory surgery centers for all company products.
• Performs a detailed insurance verification for all product and applicable procedures to the degree authorized by the SOP of the program.
• Manages a regional case load.
• Answers technical reimbursement questions for providers, billing and coding staff, and sales representatives.
• Accurately records all reimbursement correspondence and research in the database per the assigned fields and required metrics.
• Analyzes data and draws valid and logical conclusions based on information provided by insurers and documented medical policies.
• Communicates insurance verification, prior authorization, and denied claim results to customers and answers all related questions.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Prioritizes duties and tasks as necessary to ensure assignments are completed in a timely fashion. Reports any reimbursement trends/delays to Team Lead.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action.
• Performs related duties as assigned.

What we are looking for:

• Ability to make sound decisions when completing work. Ex. Prioritizing work, managing time, investigating cases worked fully prior to problem solving.
• Strong Accountability
• Ability to interact professionally at multiple levels within a client-oriented organization
• Team player
• Excellent organizational, written and verbal communication skills
• Ability to work professionally with highly confidential information, and work consistently in a fast-paced environment
• Strong knowledge of Microsoft Word, Excel, Power Point and Outlook
• Experience with Microsoft based applications, and ability to learn internal computer systems
• Flexibility and ability to adjust to changing priorities and unforeseen events
• Previous coding and billing experience in provider office or hospital setting
• Strong quality orientation including the ability to focus on details and adherence to standards while ethically maintaining a business perspective
• Able to handle high pressure situations and constructively resolve potential conflicts

Education and Training/Certification

Required:

• Experience in Reimbursement in healthcare industry

Preferred:

• Reimbursement experience within a call center environment
• Four-year college degree

Related Work Experience

• 1-3 years of customer service and reimbursement experience within the biotechnology or pharmaceutical industry with Hub Reimbursement services
• Knowledge of Medicare, Medicaid, and Private Insurer Reimbursement Methodology
• Able to interpret and analyze detailed Medical policies and coverage criteria
• Basic understanding of the benefits investigation process [deductible, out of pocket, benefits exclusions, etc.]
• Familiar with ICD 10 Coding
• Familiar with Wound Care

What we offer:

• The ability to work in an innovative industry leading products

• A commitment to professional development

• A best in class culture

• Comprehensive compensation and benefits

Smith and Nephew is an Equal Opportunity/Affirmative Action Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by applicable law.

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.

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