• Reimbursement Specialist

    Location US-MD-Columbia
    Job ID
    2018-1262
    # Openings
    2
    Category
    Reimbursement
  • Primary Purpose of Position

    The Reimbursement Specialist (RS) is responsible for various reimbursement functions, including but not limited to Intake, Data Entry, Benefit Investigations, and Call Triage.  This is a front line position in a fast paced, results driven environment. The Reimbursement Specialist (RS) 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. The Reimbursement Specialist (RS) will appropriately document all interactions into the Osiris Database system.

    Principal Responsibilities

    • Acts as single point of contact and voice for all providers, patients and product / sales team.
    • Initiates and coordinates the insurance verification for physicians, hospitals, and ambulatory surgery centers for all company products.
    • Performs a detailed insurance verification for all product and applicable procedures to the degree authorized by the SOP of the program.
    • Manages a regional case load.
    • Answers technical reimbursement questions for providers, billing and coding staff, and sales representatives.
    • Accurately records all reimbursement correspondence and research in the database per the assigned fields and required metrics.
    • Analyzes data and draws valid and logical conclusions based on information provided by insurers and documented medical policies.
    • Communicates insurance verification, prior authorization, and denied claim results to customers and answers all related questions.
    • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
    • Prioritizes duties and tasks as necessary to ensure assignments are completed in a timely fashion. Reports any reimbursement trends/delays to Team Lead. Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action.
    • Performs related duties as assigned.

    Qualifications

    • Biotechnology or Pharmaceutical background in Hub Industry or Reimbursement
    • Competent with strong problem solving
    • Strong knowledge of Microsoft Word, Excel, Power Point and Outlook
    • Ability to interact professionally at multiple levels within a client oriented organization
    • Excellent organizational, written and verbal communication skills
    • Ability to manage multiple and varied tasks, and prioritize workload
    • Ability to work professionally with highly confidential information
    • Experience with Microsoft based applications, and ability to learn internal computer systems
    • Flexibility and ability to adjust to changing priorities and unforeseen events; excellent time management skills
    • Ability to work consistently in a fast-paced environment
    • Previous coding and billing experience in provider office or hospital setting
    • Strong quality orientation including the ability to focus on details and adherence to standards while ethically maintaining a business perspective
    • Experience in Reimbursement in healthcare industry. Preferably in a call center environment
    • Four year college degree

                   Benificial Work related experience:

    • 1-3 years of customer service and reimbursement experience within the biotechnology or pharmaceutical industryKnowledge of Medicare, Medicaid, and Private Insurer Reimbursement MethodologyAble to interpret and analyze detailed Medical policies
    • Basic understanding of the benefits investigation process [deductible, out of pocket, benefits exclusions, etc.] Familiar with ICD 10 Coding
    • Familiar with Wound Care

    Able to handle high pressure situations and constructively resolve potential conflicts

     

    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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