Reimbursement Specialist (West & MidWest)

ABH has more than 120 employees committed to producing and distributing Dermagraft, a break-through product for the treatment of diabetic foot ulcers. In addition to current efforts related to Dermagraft, the Company continues to evaluate out-license and in-license opportunities to expand its role as one of the premier regenerative medicine companies in the world. We currently have an opening for a Reimbursement Specialist!

 

REIMBURSEMENT SPECIALIST:

 

Department:    Health Economics

Reports To:  Regional Manager, Health Economics 

Location:  Field-based; Midwest & West



 



This position is a critical front-line member of the Advanced Biohealing, Inc. Health Economics team. The primary purpose of this role is to support Advanced Biohealing, Inc. customers in attaining appropriate reimbursement and to support the company and department reimbursement strategy for Advanced Biohealing, Inc. products.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

 

1.  Provide appropriate coding and billing guidance.

 Establish relationships with sales representatives and accounts to provide service in an appropriate, prescribed manner that will require pre-planning for the individual account.

 Pre-sale activities with sales representatives, prospective and new customers to understand potential for coding and coverage decisions to support positive reimbursement outcomes.  Make strategic consultative calls and meet with accounts with reimbursement questions regarding the billing for Dermagraft® or other company products.  This assistance can be provided to accounts via phone/FAX communication or in person with more complex cases.

Assist accounts in identifying claims and process changes to appropriately and successfully appeal or re-bill claims. 

Investigate all denied or partially paid services with accounts and Reimbursement Hotline and provide follow-up to Health Economics Manager, sales representative, and account as appropriate regarding next steps and support needs.

 As coding, coverage and reimbursement can change, candidate must be flexible and able to adapt to account needs, as well as overall reimbursement requirements as determined by the strategic direction within the department.

 

2.  Territory Management

 Responsible for submitting individual development goals, territory business plan, monthly activity reports, expense reports and other reports as requested by the Director of Health Economics and/or Health Economics Manager in a timely fashion.

Complete assignments/projects as directed and in a timely manner.

 Demonstrate appropriate territory planning and time management skills by effectively covering the specific geographical area of responsibility.

Meet or exceed the standard level of performance in target account activity.



3.  Other Responsibilities

 

o  Provide sales support via distribution of materials and assistance to customers and sales representatives; work with Health Economics Manager to track and report on trends within territory; assist hotline staff and/or health economics managers in addressing coding, coverage or reimbursement resolutions, appeals for authorization and payment as directed.  Constantly evaluates levels of customer support and works with department personnel toward improving customer support.

o  Work collaboratively within the Health Economics Department to facilitate the overall goals and objectives.  Work well within a team-focused organization.

 

 

QUALIFICATIONS   

 

To perform this job successfully, individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

EDUCATION and/or EXPERIENCE

 

Bachelor's degree from a four-year college or university and 3+ years healthcare coding, coverage and reimbursement experience with device, pharmaceutical, biotechnology and/or health policy, coding, coverage and reimbursement matters. Specific experience/ skills needed include the following:

 Must have previous experience working with billing and medical claims personnel in various health care settings including, but not limited to a physician office, hospital, and ambulatory surgery center. 

 Must have proven expertise in medical coding, billing processes and claim submissions to public and private insurers for biotechnology products, medical devices and pharmaceuticals. Familiarity with appropriate coding terminology and processes [CPT, HCPCS, ICD-9, revenue codes and DRG], coverage and reimbursement.

 Must possess the ability to review health insurance forms [UB-4, CMS-1500, explanation of benefits, prior authorization forms], and provider encounter forms [superbills/charge tickets] to troubleshoot cases where billing, claims submission or documentation errors may occur. 

 

LANGUAGE SKILLS

 

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.  Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. 

 

This position will interact routinely with internal customers including sales representatives, product marketing and management, and occasionally with regulatory, clinical and finance departments.

 

MATHEMATICAL SKILLS

 

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. 

 

REASONING ABILITY

 

Ability to define problems, collect data, establish facts, and draw valid conclusions.

 



CERTIFICATES, LICENSES, REGISTRATIONS

 

Billing certification is appropriate but not required.

 

 

PHYSICAL DEMANDS  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position is field based and may require as much as 50% travel.

Please take a look at our website at www.advancedbiohealing.com for further company information.

All qualified resumes should be submitted directly to careers@advancedbiohealing.com

We are an Equal Opportunity Employer.