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Reimbursement Coordinator
Job Number: #2017-17
Location: St. Paul, MN

The Reimbursement Coordinator informs patients regarding their insurance company’s coverage policy for an implantable medical device, contacts healthcare insurance payers to verify benefits, and aids patients to understand how to navigate the prior-authorization process required. The Coordinator will establish and maintain strong relationships with payors, patients, providers, doctors and staff as well as in-house team-members in an effort to ensure continuity of care throughout the pre-surgical process. Experience obtaining prior authorizations for implant surgery at a physician clinic, surgery center, hospital, or health system is a plus. Healthcare insurance industry experience providing prior authorizations or administerating the appeals process is a plus. Monitors and provides updates for payor policy.

ESSENTIAL FUNCTIONS

  • Gathers information and performs benefit investigation, verification and preauthorization (as required) with employers, insurers/payors, and Veterans Administration programs.

  • Effectively manages and documents all insurance information, verification and prior authorization as well as self-pay programs.

  • Conducts financial and reimbursement analysis based upon information received from the insurance company, plan and other payor options.

  • Ensures information is received in a timely manner and oversees problem resolution related to the patient's medical record, authorization needs and billing requirements and other issues.

  • Keeps patient informed and up to date, answering questions in a timely manner and working to obtain information related to authorization needs and other requirements.

  • Keeps team-members, staff, doctors and those that need to know, up to date on coverage status.

  • Practices the highest level of confidentiality, handling information with discretion, ahereing to company policies and procedures and HIPAA guidelines.

  • Demonstrates the ability to think independently and make accurate and timely decisions, assess and resolve problems effectively.

  • Tracks patients from initial contact through resolution.

MINIMUM REQUIREMENTS

  • Bachelors Degree preferred

  • 3+ years healthcare insurance prior authorization experience, implantable medical device experience a plus

  • Knowledge of medical terminology, prior authorization and appeals process

  • Experience working in Microsoft Office, Excel, and customer relationship software

  • Experience dealing with payors - healthcare insurance, VA, medicare/medicare administrative carriers (MAC), and self-pay programs

  • Ablility to work independently, following estabilished procedures and guidelines, utilizing sound judgement and confidentiality

  • Overall knowledge of authorization, benefits and claims processing for healthcare insurance companies / plans

  • Is empathetic to patients/others, communicating effectively on the phone and face to face. Responding in a timely manner, following through on open ended items and resolving issues.

 If you are interested in applying for this position, please fill out this form to submit your resume.