Reimbursement Specialist
3 weeks ago
Transforming Healthcare through Reimbursement Excellence
At Hill-Rom, we are committed to delivering exceptional patient care and outcomes. As a Reimbursement Specialist, you will play a critical role in ensuring that our products and services are accessible to those who need them most.
Your Key Responsibilities
- Verify patient eligibility and benefits to determine coverage and payer requirements.
- Ensure accurate benefit information is loaded to reduce rework and facilitate clean claims.
- Gather clinical documentation to support medical necessity for our Respiratory Health products.
- Assess clinical documentation to ensure compliance with applicable prescription, face-to-face, and coverage criteria requirements.
- Prepare and submit prior authorization requests to insurance companies, including commercial payers and government payers.
- Process authorization decisions from payers in a timely manner to streamline revenue.
- Negotiate payment rates for letter of agreement to maximize collection potential.
- Provide exceptional customer service by communicating payer policies, coverage criteria, benefit limitations, and product information to patients and healthcare teams.
- Understand and adhere to all policies for Hill-Rom and third-party payers to ensure the highest standards of quality and compliance.
- Contribute to team goals and understand how they support greater organizational objectives.
What We're Looking For
- Associate's degree or higher preferred.
- 3+ years of industry experience, preferably in health insurance and/or durable medical equipment.
- Third-party payer experience strongly preferred.
- Exceptional written, verbal, and interpersonal communication skills.
- Strong critical thinking and problem-solving skills.
- Detail-oriented and ability to multitask.
- Ability to work independently and in a team environment.
- Proficiency in Microsoft Office software.
- Experience with Total Information Management System (TIMS) a plus.
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