We are looking for an experienced Reimbursement Supervisor to complete activity of the reimbursement hub program to which the employee is assigned. Includes researching and analyzing moderate to complex reimbursement policies. Interaction with senior level client contacts. Handling of escalated cases/issues in the assigned area.
|TYPE:||Exempt, Salaried, Full Time|
|JOB NATURE:||Office based desk position, Heavy phone and computer usage, minimal lifting.|
|JOB SUMMARY:||Support and help lead a team of reimbursement case managers who support product access for both medical and pharmacy benefits, commercial and government payers as well as alternate funding agencies. The role will support a variety of products, including medicinal foods.|
|JOB DUTIES:||Help to manage day to day activity of the programs, as assigned; specific tasks assigned by program manager/director; including management of program telephone queue
Complete quality monitoring and quality assurance activities for team Case Managers
Coach/mentor staff in case management, intake coordination and other roles
Prepare client facing and internal reports, as required
Assist in training team members, including on program specific Standard Operating Procedures (SOPs)
Draft SOPs, Work Instructions, business rules internal tools
Test and assist in determination of CRM, telephony and other system tool needs
Manage mailings, fax and email blasts, as assigned
Perform case management activities as needed/assigned
Assist callers/clients with coverage needs, billing and coding, insurance benefit investigations, prior authorization, and appeals inquiries.
May act as regional contact for senior level client representatives.
Review and resolve denied or underpaid insurance claims.
Monitor and update payer prior authorization requirements and coverage policies for specified client program.
Host conference calls with senior level client contacts as required by program guidelines.
Travel to and attend client meetings, off site training, and/or conferences. Travel time estimate: 10%.
|TRAINING, EDUCATION, EXPERIENCE:||Must be 18 years old or older.
Bachelor’s degree or relevant experience.
Minimum four years recent healthcare experience (2 years’ direct industry preferred).
Advanced knowledge of medical insurance (public and commercial), billing and coding and associated terminology.
Excellent customer service skills (call center experience preferred).
Advanced problem solving, research and analytical skills.
Advanced communication skills, both written and verbal.
Data entry accuracy required.
Ability to multi-task and manage time independently.
Client interaction experience preferred.
|TIME COMMITMENT:||Monday through Friday
Minimum 40 work hours Full Time