Position Description: Reimbursement Specialist

Job Title | Reimbursement Specialist
Location | East, USA
Department | Reimbursement

Summary

This position is a critical front-line member of the Advanced BioHealing, Inc. Government Affairs / Health Economics team. The primary purpose of this role is to support Advanced BioHealing, Inc. customers in obtaining appropriate reimbursement and to support the company and department reimbursement strategy for Advanced BioHealing, Inc. products.

Essential Duties and Responsibilities

The duties and responsibilities of this position include the following, although other duties may be assigned.

1. Provide appropriate coding and billing guidance.

• Establish relationships with sales representatives and customers to provide service in an appropriate, prescribed manner that will require pre-planning for the individual account.
• Reimbursement educational activities with sales representatives, prospective and new customers to understand potential for coding and coverage decisions to support positive reimbursement outcomes. Make strategic consultative calls and meet with accounts with reimbursement questions regarding the coding, coverage and reimbursement for Dermagraft® or other company products. This assistance can be provided to accounts via phone/FAX communication or on-site visits with more complex cases.
• Assist customers in identifying claims and process changes to appropriately and successfully appeal or re-bill claims.
• Investigate all denied or partially paid services with customers and Reimbursement Hotline and provide follow-up to Health Economics Manager, sales representative, and customer as appropriate regarding next steps and support needs.

Coding, coverage and reimbursement can change, and individual must be flexible to anticipate and adapt to customer needs, as well as overall reimbursement requirements as determined by the strategic direction within the department and as required by government and non-government payers.

2. Territory Management

• Responsible for submitting individual development goals, territory business plan, monthly activity reports, expense reports and other reports as requested by the Director of Health Economics and/or Health Economics Manager in a timely fashion.
• Complete assignments/projects as directed and in a timely manner.
• Demonstrate appropriate territory planning and time management skills by effectively covering the specific geographical area of responsibility.
• Meet or exceed the standard level of performance in target account activity.

3. Other Responsibilities

• Provide sales support via distribution of reimbursement materials and assistance to customers and sales representatives; work with Health Economics Manager to track and report on trends within territory; assist hotline staff and/or health economics managers in addressing coding, coverage or reimbursement resolutions, appeals for authorization and payment as directed. Constantly evaluate levels of customer support delivered and work with department personnel toward improving customer support.
• Work collaboratively within the Government Affairs Health Economics Department to facilitate the overall goals and objectives. Work cooperatively within a team-focused organization.

Supervisory Responsibilities

Position has no supervisory responsibilities.

Qualifications

To perform this job successfully, individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

Bachelor's degree from a four-year college or university and 3+ years healthcare coding, coverage and reimbursement experience with device, pharmaceutical, biotechnology and/or health policy, coding, coverage and reimbursement matters. Specific experience/ skills needed include the following:

• Must have previous experience working with billing and medical claims personnel in various health care settings including, but not limited to a physician office, hospital, and ambulatory surgery center.
• Must have proven expertise in medical coding, billing processes and claim submissions to public and private insurers for biotechnology products, medical devices and pharmaceuticals. Also maintain familiarity with appropriate coding terminology and processes [CPT, HCPCS, ICD-9, revenue codes and DRG], coverage and reimbursement.
• Must possess the ability to review health insurance forms including UB-04, CMS-1500, explanation of benefits, and prior authorization forms, as well as provider encounter forms [superbills/charge tickets] to troubleshoot cases where billing, claims submission or documentation errors may occur.

Language Skills

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.

This position will interact routinely with internal customers including sales representatives, product marketing and management, and occasionally with finance, regulatory, and clinical departments.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions.

Certificates, Licenses, Registrations

Billing certification is appropriate but not required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position is field based and may require as much as 25% travel.

We offer a competitive benefits & compensation package!

All qualified resumes should be submitted directly to careers@abh.com

We are an Equal Opportunity Employer.