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Organogenesis · 2 weeks ago

Provider Benefit Verification Specialist II

Canton, MA

Full-time

Hybrid

Mid Level

$60K/yr - $70K/yr

3+ years exp

Organogenesis is a leading regenerative medicine company specializing in advanced wound care products. They are seeking a Provider Benefit Verification Specialist II to provide billing and reimbursement support to sales specialists and customers, ensuring effective communication and documentation of payer trends and policies.

BiotechnologyHealth CareManufacturingMedical

Responsibilities

Investigate patient’s medical benefits and identify opportunities for prior authorizations

Prepare and submit prior authorizations in a timely manner

Effectively interface with hospitals, wound care centers and physicians to ensure the highest level of reimbursement is attained

Communicate and accurately document payer trends

Foster partnerships with national accounts

Monitor and update Medicare, Medicaid and private payer policies and guidelines

Monitor and communicate policy developments that impact the reimbursement success of products

Help build relationships in key markets with government, physician, hospital, and third-party payer decision makers

Demonstrate a strong understanding of payer policies and how to leverage this knowledge to support the benefit verification process

Understand and utilize reimbursement tools to minimize customer inquiries

Ability to meet strict metrics for quota and turn-around time

16-22 Reimbursement cases completed consistently

Comply with all company policies and procedures

Other duties as needed

Qualification

Healthcare reimbursementPrior AuthorizationMedicare knowledgeCustomer serviceProfessional communicationPolished presenceDetail-oriented

Required

High school diploma or equivalent required

3+ years' experience working in Healthcare reimbursement required

1+ year of Prior Authorization experience required

Functional expertise in reimbursement and healthcare policy, with strong knowledge of Medicare, Medicaid, managed care and private payer reimbursement process required

Ability to communicate in a professional manner with providers, insurances, and internal customers and colleagues required