• Reimbursement Case Advocate

    Location US-MD-Columbia
    Job ID
    2018-1270
    # Openings
    1
  • Primary Purpose of Position

    The Reimbursement Case Advocate (RCA) is responsible for supporting various reimbursement functions, including but not limited to Intake, Data Entry, Benefit Investigations, Call Triage, Prior Authorizations, Pre Determinations, and Appeals support. The Reimbursement Case Advocate (RCA) responds to all provider account, patient, and internal inquiries in a timely fashion. The Reimbursement Case Advocate (RCA) will appropriately document all interactions with provider, payer and related customers into the Osiris Database system.

    Principal Responsibilities

    • Acts as single point of contact and voice for all providers, patients and product / sales team.
    • Serves as a patient advocate and enhances the collaborative relationship between, payer, provider and sales team.
    • Primary function is to provide Prior Authorization, Pre-Determination and Appeals support to customer.
    • Proactively reviews all clinical notes with benefit verifications to be sure coverage criteria is met per payer guidelines.
    • Analyzes data and draws valid and logical conclusions based on information provided by insurers and documented medical policies.
    • Tracks and follows up on all PA, PreD requests and reports on status updates to customer.
    • 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.
    • Provide assistance to physician office staff to complete all necessary PA/Pre-D forms and gather any missing information in a timely manner to submit to insurance payers.
    • Provides all necessary documentation required to expedite prior authorization requests including demographic, authorization/referrals, National Provider Identification (NPI) number and referring physicians.
    • Initiates and coordinates the insurance verification for physicians, hospitals, and ambulatory surgery centers for all company products as needed.
    • Accurately records all reimbursement correspondence and research in the database per the assigned fields and required metrics.
    • 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
    • Able to handle high pressure situations and constructively resolve potential conflicts
    • Experience in Reimbursement in healthcare industry

    PREFERRED:

    • Four year college degree
    • Reimbursement experience within a call center environment

    RELATED WORK EXPERIENCE:

    • 1-3 years of customer service and reimbursement experience within the biotechnology or pharmaceutical industry
    • Knowledge of Medicare, Medicaid, and Private Insurer Reimbursement Methodology
    • Able 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

    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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