[Hiring] Reimbursement Case Advocate @Smith+Nephew

Role Description

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.
• Reporting patient coverage based on payer coverage criteria and reimbursement information to the requesting healthcare provider.
• Ensuring data quality/integrity and documenting all interactions related to the benefit investigation into a dedicated database.
• Providing best-in-class customer service support for all outbound provider communication and inbound calls, including case escalations as appropriate.
• Following company policies, procedures, and compliance directives at all times.
• Managing all protected health information (PHI) appropriately within the governing Health Insurance Portability and Accountability Act (HIPAA) guidelines.

What Will You Be Doing?

• Performing a detailed insurance benefit verification for all products, including obtaining patient responsibility, researching payer coverage criteria, and any required prior authorization requirements.
• Maintaining clear documentation of all tasks, reviewing reports for accuracy and completeness, preparing and sending insurance benefit verification results to healthcare providers, and protecting PHI, all within the department's directed time allotment.
• Reporting any payer delays/reporting challenges and escalating complaints accordingly to Team Lead and/or Supervisor as necessary.
• Collaborating with Market Access and Patient Access Reimbursement Manager (PARM) teams to further investigate reporting issues or changes in payer coverage criteria.
• Performing related duties as assigned.

Qualifications

• 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.

Requirements

• 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.

Benefits

• 401k Matching Program, 401k Plus Program, Discounted Stock Options, Tuition Reimbursement.
• Flexible Personal/Vacation Time Off, Paid Holidays, Flex Holidays, Paid Community Service Day.
• Medical, Dental, Vision, Health Savings Account (Employer Contribution of $500+ annually), Employee Assistance Program, Parental Leave, Fertility and Adoption Assistance Program.
• Hands-On, Team-Customized, Mentorship training.
• Discounts on fitness clubs, travel, and more!