Reimbursement Case Advocate

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 Case Advocate 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, and will be responsible for data quality/integrity and appropriately document all interactions related to the benefit investigation into a dedicated database.

The Reimbursement Case Advocate 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 Case Advocate 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.

What Will You Be Doing?

• Performs a detailed insurance benefit verification for all products including obtaining patient responsibility, researching payer coverage criteria, and any required prior authorization requirements.
• 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.
• Reports any payer delays/reporting challenges and escalates complaints accordingly to Team Lead and/or Supervisor as necessary
• Collaborates with Market Access and Patient Access Reimbursement Manager (PARM) teams to further investigate reporting issues or change in payer coverage criteria.
• Performs related duties as assigned.

What Will You Need to Be Successful?

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 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 patient benefits verification, including health plan benefits and prior authorizations.
• Prior experience with ICD 10 Coding.
• Prior experience working for a medical or pharmaceutical reimbursement hub or hotline.
• Previous coding and billing experience in the healthcare industry

Preferred

• Basic understanding of Data Entry/CRM programs (Salesforce, Dynamics365)
• Intermediate knowledge of Microsoft Office Suite.

Competencies

• Exceptional Customer Service skills
• Strong attention to quality and details
• Strong work ethics and accountability
• Ability to interact professionally at multiple levels
• Effective communication skills (oral, written, listening, non-verbal)
• Excellent organizational and time management skills
• Strong critical thinking skills
• Flexibility and adaptability to change
• Able to handle high volume case situations in a fast-paced environment

Travel Requirements: Up to 10%.