Field Reimbursement Manager

Role Summary

The Field Reimbursement Manager will support a Regional Sales Team and customers to help navigate the patient access and reimbursement landscape to MiMedx products.

Responsibilities

• Conduct training and education for new and existing customers on MiMedx Insurance Verification Request (IVR) process, billing, coding, place of service reimbursement, and national and local coverage policies by in-person meetings, email, phone, and WebEx
• Serve as the primary reimbursement contact for a Regional Sales Team being the subject matter reimbursement expert
• Work as liaison with provider accounts and field sales to provide information required to timely complete IVR cases with the Patient Insurance Verification Team (PIVT).
• Provide Payer coverage and reimbursement updates to both internal and external customers
• Follow-up with accounts to ensure proper payment of claims, identify any reimbursement issues, and work with the account to resolve
• Investigate all denied or partially paid services and provide guidance regarding next steps and support needs
• Conduct claim reimbursement reviews to monitor accurate payments; provide detailed analysis and identify billing errors
• Meet or exceed quarterly Metric Based Objectives (MBO) pertaining to education and communication of reimbursement and coverage of MiMedx products
• Conduct quarterly consignment product audits with Account Executives
• Report changes in coverage/reimbursement trends and global concerns in this area to management to ensure corrective actions and mitigation of future occurrences
• Troubleshoot national and local payer reimbursement issues
• Adhere to HIPAA policies and procedures to ensure compliance
• Adhere to the organization‚Äôs appeal strategy and manage its on-going tactical application to ensure a successful reversal rate

Qualifications

• BS/BA in related discipline
• 2+ years of buy and bill medical benefit reimbursement experience
• OR
• MS/MA and 1-3 years of experience in related field. Certification is required in some areas
• Familiarity with medical policy for insurance payers; Medicare, Medicaid, and Commercial
• Strong understanding of CMS and final-rules and methodologies, experience with multiple places of service requirements, comprehension of Commercial Insurers (Aetna, Anthem Blue Cross Blue Shield, Cigna, Humana, United Health Care)
• Experience with Salesforce based CRM systems preferred
• Prefer sales or account management experience
• Strong understanding of medical coding including ICD10, CPT and HCPCS codes
• Strong understanding of medical management and health insurance concepts, information systems and strong analytical and problem-solving skills
• Performs full range of standard professional level work that typically requires processing and interpreting, more complex, less clearly defined issues. Identifies problems and possible solutions and takes appropriate action to resolve.

Skills

• Excellent oral, written, and interpersonal communication skills
• Ability to interact with all levels of management, both internal and external, third party payers, and customers
• Organized, flexible, and able to multi-task while maintaining a high level of efficiency and attention to detail
• Strong analytical skills, clinical interests, strategic and technical analysis and problem-solving skills
• Ability to influence others to achieve desired results using tenacity and diplomacy
• Fully competent and productive professional contributor, working independently on larger, moderately complex projects/assignments that have direct impact on department results

Education

• BS/BA in related discipline
• MS/MA degrees with relevant field experience as applicable

Additional Requirements

• Travel is required 20% to 30% of time (2‚Äì3 days a week, a few weeks per quarter) to build solid account relationships