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Senior Reimbursement Specialist
Location
United States
Posted
9 days ago
Salary
0
Seniority
Senior
Job Description
Senior Reimbursement Specialist
Merit Medical Oncology
• Supports execution of reimbursement strategies aligned with business priorities and product lifecycle needs • Provides reimbursement and health policy guidance to clinical, regulatory, marketing, and sales partners • Contributes to evidence planning by partnering with HEOR to identify payer‑relevant data needs • Analyzes reimbursement landscapes and supports development of coding, coverage, and payment pathways and internal and external communication tools • Educates internal teams on reimbursement requirements, payer trends, and implications for product adoption • Identifies reimbursement barriers and supports implementation of solutions to improve patient access • Develops and delivers reimbursement education for internal teams and external stakeholders • Performs other duties, as required
Job Requirements
- Bachelor’s degree required; advanced degree preferred
- Minimum of 8 years of experience in reimbursement, market access, or health policy within medical devices, med-tech, insurance, or healthcare administration
- Strong understanding of U.S. coverage, coding, and payment systems
- Demonstrated ability to support reimbursement strategy in a matrixed environment
- Proficiency with standard business applications (e.g., MS Word, Excel, data analysis tools)
- Coding certification (e.g., CPC) preferred
Benefits
- Multiple Shifts and Hours to choose from: Days, Swing (Eve), and Nights
- Medical/Dental & Other Insurances (eligible the first of month after 30 days)
- Low Cost Onsite Medical Clinic
- Two (2) Onsite Cafeterias
- Employee Garden | Gardening Classes
- 3 Weeks' Vacation | 1 Week Sick-Time | Paid Holidays
- 401K | Health Savings Account
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• Provide high quality customer service • Effectively interface with patients, patient’s families, national payers, home cares and medical doctor’s offices • Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices • Submit and obtain prior authorizations as required by payer • Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval • Accurately enter and maintain data as required in client database and patient files • Utilize the client database to monitor outstanding items on each client case file • Ensure files are complete so team can determine the current status • Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases • Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient • Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies • Educate patients, prescribers, and others regarding program requirements, and facilitate referrals • Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures
• Bristol Hospice is a nationwide industry leader committed to providing a family-centered approach in the delivery of hospice services throughout our communities. • We are dedicated to our mission that all patients and families entrusted to our care will be treated with the highest level of compassion, respect, and dignity.
• Assure all insurance claims are processed timely, accurately, and efficiently • Secure payments from both contracted and non-contracted insurance entities as well as customers • Work closely with Customer Sales Support to assure data accuracy and communication of requirements from health insurance plans • Review medical criteria to assure patient documentation meets standards • Carefully review all patient related data and documentation for accuracy prior to claim submission • Create and submit healthcare claims to insurance companies • Communicate with patients to advise on status of insurance claims, as necessary • Contact patients regarding collection of outstanding invoices • Field inbound calls from patients regarding inquiries related to insurance claims • Make outbound investigational calls to insurance providers to determine status of outstanding claims • Negotiate structured payment plans • Access CRM to receive and provide up to date patient claim information • Keep up to date with specifications on all of Tandem products and services • Confirm completion of required training plan before assuming job responsibilities • Ensure work is performed in compliance with company policies including Privacy/HIPAA and other regulatory, legal, and safety requirements



