Reimbursement Lead Associate (RLA)

Location US-MD-Columbia
Job ID
2015-1127
Category
Reimbursement

Primary Purpose of Position

The Reimbursement Lead Associate is responsible for all aspects of the insurance verification, prior authorization, and claims appeal processes for the supported products.  This is a front line position in a fast paced, results driven environment.  The RLA responds to all provider, patient, and internal requests in a timely fashion and is responsible for providing patient specific coding, coverage, and reimbursement information to the hotline’s customers.

 

Principal Responsibilities

** In addition to the execution of the core RLA functions listed below, the reimbursement lead associate must possess an elevated awareness of his/her responsibility to the team and obligation to the team’s ongoing functioning and overall success.**  This elevated responsibility will be demonstrated by the following: research and resolution of escalated issues, assistance with training, peer review/shadowing, Reimbursement Business Manager and Sales Rep communication, payer research, and special projects as assigned by leads and manager.  In addition, the RLA must be able to manage his/her case load with minimal direction from the supervisor and manager.

  1. Initiates and coordinates the insurance verification and prior authorization processes for physicians, hospitals, and ambulatory surgery centers for all company products.
  2. Performs a detailed insurance verification for all product and applicable      procedures.
  3. Obtains product and procedure reimbursement rates and special billing rules.
  4. Relays coordination of benefits between primary, secondary, and tertiary  insurers.
  5. Answers technical reimbursement questions for providers, billing and coding staff, and sales representatives.
  6. Accurately records all reimbursement correspondence and research in the database per the assigned fields and required metrics.
  7. Analyzes data and draws valid and logical conclusions based on information provided by insurers and documented medical policies.
  8. Communicates insurance verification, prior authorization, and denied claim results to customers and answers all related questions.
  9. Researches customer questions as necessary and communicates with appropriate internal stakeholders to ensure highest level of customer service.
  10. Prioritizes duties and tasks as necessary to ensure assignments are completed in a timely fashion.
  11. Ensures continuous quality improvement and customer service by proactively identifying areas of improvement and communicates those ideas to the management team.
  12. Coordinates responses and resolutions to issues with appropriate internal and external parties.
  13. Maintains and promotes positive and professional working relationships with associates and management.
  14. Performs related duties as assigned.

 

 

 

 

Qualifications

QUALIFICATIONS  To perform this job successfully, an 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.

 

  1. Four Year College degree preferred
  2. Coding and billing experience in the office, hospital, or ASC settings
  3. Experience in a reimbursement based call center environment preferred.

 

EDUCATION and/or EXPERIENCE

 

  1. 1-3 years customer service, reimbursement experience preferred
  2. Knowledge of Medicare, Medicaid, and Private Insurer Reimbursement Methodology
  3. Able to interpret and analyze detailed Medical policies
  4. Basic understanding of the benefits investigation process [deductible, out of pocket, benefits exclusions, etc.]
  5. Experience with the prior authorization process for products/services
  6. Ability to communicate effectively both orally and in writing
  7. Adept at handling sensitive and confidential situations
  8. Strong interpersonal skills
  9. Strong analytical skills
  10. Strong organizational skills; attention to detail
  11. Ability to resolve associate issues quickly and efficiently
  12. Ability to represent a positive and professional image
  13. Strong knowledge of Microsoft Word, Excel, Power Point and Outlook

 Osiris Therapeutics, Inc. is an Equal Opportunity Employer with a commitment to diversity. Applicants are considered on the basis of individual merit without regard to race, color, national or ethnic origin, gender, gender identity, sexual orientation, marital status, veteran status, pregnancy, age, religion, disability, genetic information, or any other characteristic protected by law.

 

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