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Novocure · 1 hour ago

Reimbursement Specialist II

Portsmouth, NH

Full-time

Onsite

Mid Level

3+ years exp

Novocure is a company focused on developing and commercializing innovative therapies for cancer. The Reimbursement Specialist II is responsible for executing reimbursement processes to confirm medical necessity and secure payments, while collaborating with cross-functional teams to support reimbursement operations and achieve team KPIs.

BiotechnologyHealth CareMedical DeviceOncology

Responsibilities

Conduct timely insurance benefit verifications to determine patient eligibility and cost-share responsibilities for both new and existing patients

Ensure the responsible “bill-to” insurance party is set up correctly in each assigned account

Submit authorization requests to insurance carriers and follow up via phone or insurance portals independently with limited supervision

Interpret authorization denials and draft appeals, leveraging all available resources, independently

Research and understand commercial payers' medical policies and guidelines for coverage

Verify the presence and accuracy of authorizations and pricing agreements for all insured patients

Differentiate between contract and non-contract carriers, including identifying contacts for potential letter of agreement (LOA) negotiations

Escalate contracting implementation challenges and identify opportunities for process improvement

Collaborate cross-functionally with other departments to ensure timely and accurate reimbursement from insurance providers

Investigate and resolve all incorrect payments and escalate trends in change behavior as identified

Submit and track the status of claim appeals for payment disputes

Identify, report, and work to resolve the need for a claims project

Communicate with key personnel within managed care organizations, such as nurse case managers, to streamline the reimbursement processing for patients

Identify and escalate contracting implementation challenges and opportunities

Identify and suggest solutions to authorization processing issues based on payer policies and/or behavior

Perform additional duties and respond to shifting priorities as assigned by management

Identify new trends in authorization denials by payer

Independently follow-up on insurance authorization requests and claim status via phone and insurance website in a timely manner

Qualification

Reimbursement experienceMedical terminology knowledgeInsurance communicationMicrosoft Office proficiencySAP proficiencyCustomer service excellenceDe-escalation skillsProblem-solving skillsIndependent work abilityTeam collaboration