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Perform Reimbursement Specialist duties for assigned territory or payer(s) including eligibility and benefit verification, documentation collection, prior authorization and reauthorization submissions, letter of agreement payment negotiations, and processing payer decisions. Communicate directly with patients, healthcare teams, and insurance companies as well as collaborating cross-functionally with teams to coordinate in our mission of enhancing outcomes for patients and their caregivers.
Job Responsibility:
Perform verification of eligibility and benefits to determine coverage and payer requirements
Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims
Gather clinical documentation to support medical necessity for Cardiology products
Assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met
Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid
Process authorization decisions from payers timely to streamline and drive revenue
Negotiate payment rates for letter of agreement to ensure maximum collection potential
Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, or any pertinent product information with patients and healthcare teams
Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance
Consistently contribute to team goals and understand how they support greater organizational goals
Requirements:
3+ years of industry experience, preferably in health insurance and/or durable medical equipment
Third party payer experience strongly preferred
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment
Possess the ability to manage time and prioritize critical priorities
Proficiency in Microsoft Office Software
Nice to have:
Experience with Total Information Management System (TIMS) a benefit
What we offer:
Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service