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Reimbursement Specialist I

2 months ago

Portsmouth, New Hampshire, United States Novocure Full time
Job Summary

The Reimbursement Specialist I is responsible for ensuring the accurate pricing and adjudication of DME claims to minimize the financial burden of Novocure and our patients. This position is focused on claims follow-up and denial resolution, and will be responsible for collaborating with and supporting the other Revenue Operations functional teams.

Key Responsibilities
  • Perform insurance benefit verifications to confirm active coverage
  • Follow-up on outstanding insurance balances via phone and insurance website in a timely manner
  • Investigate and resolve all incorrect payments and escalate trended changes in behavior as identified
  • Submit and track the status of claim appeals for payment disputes
  • Identify the need for a claims project
  • Verify presence of and accuracy of prior authorizations and pricing agreements for all patients with insurance
  • Identify and escalate contracting implementation challenges and opportunities
  • Perform all other duties or priorities assigned by management as needed
Qualifications
  • Associates degree or equivalent experience preferred
  • 0-2 years' experience in a reimbursement-related function, DME-specific experience preferred
  • Maintain integrity and tenacity while working accounts
  • Ability to understand and escalate difficult situations
  • Ability to collaborate with key internal and external teams
  • Ability to solve problems and set priorities
  • Ability to work independently with minimal supervision
  • Ability to work efficiently and cooperatively in a fast-paced office setting
  • Familiarity with medical policies and payer contracts preferred
  • Familiarity with basic medical and insurance terminology preferred
  • Familiarity with Microsoft Office and SAP preferred
  • Fundamental written and verbal communication skills with internal and external customers
  • Fundamental customer service skills