Patient Care Coordinator/Benefit Verifications Job in Canton 02021, Massachusetts US

JOB SUMMARY Provide billing and reimbursement support to sales specialists and customers.

KEY RESPONSIBILITIES

Investigate patient’s medical benefits and identify opportunities for prior authorizations.
Prepare and submit prior authorizations in a timely manner.
Effectively interface with hospitals, wound care centers and physicians to insure the highest level of reimbursement is attained.
Communicate and accurately document payor trends.
Foster partnerships with national accounts.
Monitor and update Medicare, Medicaid and Private Payor policies and guidelines.
Monitor and communicate policy developments that impact the reimbursement success of products.
Help build relationships in key markets with government, physician, hospital, and third-party payer decision makers.
Other duties as needed.

COMPETENCIES

Reimbursement Knowledge

Possess the concepts and demonstrates the ability to optimize reimbursement for Organogenesis products and services in which the products are used.This includes analyzing coding, analyzing claims, coverage and payment policies as needed for new/existing products and new business development. These integrated behaviors will shape internal decisions, enhance customer perceptions, and influence public policy to protect and increase sales.
Understands the dynamic interplay between governmental agencies/advisory boards and how they affect reimbursement.
Demonstrates a strong understanding of payer policies and how to leverage this knowledge to support company business.
Resolves most denied claim issues.
Understands how Reimbursement affects product development, market adoption and business goals.
Cultivates strong working relationships and exchanges information with key opinion leaders in medical practice, internal customers, professional medical organizations, and affiliated industry groups.
Identifies and creates new programs/tools that help sales reps provide value to customers.

Customer Relations

Ability to work effectively with internal and external customers in providing information on Organogenesis, its products, and reimbursement policy issues/concerns; and engage and influence others to partner on strategy development/implementation initiatives to ensure business interests are adequately protected/addressed.
Demonstrates the ability to effectively communicate to Corporate/ Sales teams on how to use the necessary tools to support the Reimbursement/HIPAA policy-related objectives.
Demonstrates an ability to “sell” reimbursement/other policy-related initiatives.

Job Requirements:

BA/BS degree in Health care Administration, Business, Economics.
Three plus years of work experience in the health care industry.
Medical device or biologics experience preferred.
Functional expertise in reimbursement and health care policy is necessary.
Must possess an intimate knowledge of Medicare, Medicaid, Managed Care and Private Payor reimbursement process.

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