AtMIMEDX, our purpose starts with helping humans heal. We are driven by discovering and developing regenerative biologics utilizing human placental tissue to provide breakthrough therapies addressing the unmet medical needs for patients across multiple areas of healthcare. Possessing a strong portfolio of industry leading surgical & advanced wound care products combined with a promising clinical pipeline, we are committed to making a transformative impact on the lives of patients we serve globally.

We are excited to add a Reimbursement Specialist to our Market Access team! The position will pay between $53,000 - $65,000 based on previous relevant experience. This is a 100% fully remote role!

POSITION SUMMARY:

Determine eligibility and benefits, answer billing questions, and obtain authorizations and predeterminations. Process insurance verification requests and secure prior authorization approvals for eligibility and benefit coverage. Answer questions as it relates to medical verifications of insurance policies, coding, billing, and claims. Conduct effective communications with the physician’s office, Health Plan, and the Company’s sales team. Follow all necessary policies, procedures, processes and systems in order to obtain accurate coverage information and optimize the maximum reimbursement levels.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Receive and process assigned clinical authorizations and insurance verification requests (IVR’s) from data intake team
• Review IVR and correct data entry errors and omissions (e.g. incorrect Health Plan, missing information, etc.)
• Determine if payer already in database; if not, research payer on website to obtain demographic information and forward to senior team member for data entry
• Obtain benefit coverage levels and prior authorization requirements from Health Plan, submit required paperwork, and follow-up on coverage requests and prior authorizations
• Enter coverage levels and/or prior authorization requirements for assigned accounts in database
• Research and review electronically stored health policy notes and historical reimbursements, coverage information provided by Health Plan, and procedural information (e.g. diagnosis, product, place of service, etc.) from provider to aid in making accurate coverage determinations
• Analyze and interpret collected data, obtain additional information as needed, make coverage determination, and notify provider of decision
• Collaborate with sales and field reimbursement teams to get complete and correct information to process IVR’s
• Respond to questions from physicians, hospitals, outpatient facilities/ambulatory care centers, etc. regarding billing, coding procedures, and processes
• Review and complete daily pending case reports to ensure prompt processing and closure of IVR’s and authorization requests
• Identify and escalate issues as they may arise throughout the process; report IVR quality issues in an effort to minimize errors in processing and coverage determinations
• Follow HIPAA policies and procedures to ensure compliance
• Report changes/issues in coverage/reimbursement trends to management

EDUCATION/EXPERIENCE:

• BS/BA in related discipline. Certification may be required in some areas.
• 1-2 years of experience in related field, or verifiable ability,

OR

• MS/MA/MBA and 0-1 years of experience in related field

• 1-2 years of experience in insurance verification, billing/claims processing, data processing
• Good knowledge of medical coding including ICD10, CPT and HCPCS codes
• Good understanding of Medicare, Medicaid, and Commercial and health plans
• Good understanding of medical management, health insurance concepts, information systems
• Good understanding of HIPAA rules