The Part-time Reimbursement Support Specialist will work interactively with patients, healthcare providers and our device and biotech clients in a number of therapeutic areas. Responsibilities will include but not be limited to: responding to callers' questions related to coding, coverage and payment; provider guidance and education; benefit investigations, prior authorization and appeal support; policy research; and Ad Hoc projects. This visible position will interface with clients' management and sales staff, market access, physicians and their office personnel and billing departments, patients and third party payers. This is a work from home position, with occasional meetings and training held in the greater Boston area, so candidates must be in commuting distance to Boston for occasional meetings and training.
ESSENTIAL DUTIES & RESPONSIBILITIES
Provide a high level of customer service and reimbursement support to client's internal and external customers. Point-of-contact for providers and their patients seeking insurance coverage
* Responsible for managing all aspects of the reimbursement case management process from benefit verification to prior authorization to appeals; includes customer interactions and timely follow-ups
* Responsible for answering, researching, and escalating, as needed, caller reimbursement inquiries.
* Gathers and reviews all patient and clinical documentation required by payers for medical review.
* Conducts case related research (e.g., payer coverage policies, self-funded employee benefit plans, state, and federal regulations),
* Responsible for drafting and submitting timely prior authorization and appeals letters to payers for patients
* Enters and monitors patient cases, case related activities, and caller requests in the CRM database for each client
* Reports to management on reimbursement trends, payer wins, customer complaints, as well as any opportunities to improve process
* Engages in project-related work on an as needed basis (e.g., coverage and coding research)
* Have a working knowledge of and follow all laws and policies that apply to this position, and maintain the highest levels of professionalism, ethics, and compliance always
The part-time schedule can be flexible, but this person will need to be available to work a shift between 9AM and 3:00PM EST with total roughly 25-30 hours per week. Days of week are also flexible, but Mondays and Fridays are priority.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
HR@insightglobal.com.
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- 2-5+ years of experience in a reimbursement role within healthcare
- Experience with prior authorizations and benefits verification processes
- Strong understanding of insurance policies and procedures
- Experience working in the medical device space
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.