Reimbursement & Benefits Specialist

The Reimbursement Specialist will be responsible for managing and supporting programs to support patients and health care practitioners in access to Interventional Urology related procedures. This person will use client information and insurance management knowledge to act as an advocate for our customers regarding insurance matters to ensure a smooth order process workflow within the Interventional Urology business.

Major Areas of Accountability

• Act as an advocate for our customers as it relates to coverage
• Contact insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for customers
• Help customers in obtaining authorization, or pre-certifications required for patients to access coverage for Coloplast's Interventional Urology products.
• Knowledge of commercial payers, Medicare and Medicaid and their benefit structure(s)
• Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical necessity.
• Educates customers, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Assist and/or update customers and customer support team on status in appeals if required by insurance payer.
• Ability to communicate reimbursement and access topics concisely and clearly to office staff and/or patients
• Work with customers if an exception to coverage is needed.
• Answer incoming calls from customers / patients and about the insurance verification process using appropriate customer service skills and in a professional, knowledgeable, and courteous manner.
• Runs details reports and analyzes coverage data and trends
• Create and provide CoC's for finished goods as requested by sales subsidiaries

• Conform with Coloplast Q/EHS Policy

• Other duties as assigned

Basic Qualifications

• High School Diploma

Required Knowledge, Skills and Abilities

• 3+ years' experience with insurance benefit verification and prior authorizations at either an insurance payer or within medical revenue cycle management
• Excellent written and oral communication skills
• Self-driven, pro-active; high-performance and results orientation that can work in a semi-autonomous role
  

  
  At Coloplast, we believe in recognizing and rewarding the contributions of our employees. Our total rewards package is designed to support your well-being, foster your professional growth, and ensure a healthy work-life balance. Here is some of what you can expect:

  
  
  
  
  • Health and Wellness: Comprehensive medical, dental, and vision insurance plans to keep you and your family healthy. Plus, access to company sponsored wellness programs and mental health resources, paid leave of absence for qualifying events.
  • Financial Security: A competitive 401(k) plan with company match that vest immediately, financial planning services to help you secure your future, and corporate discount programs for goods and services.
  • Work-Life Balance: Generous paid time off, flexible work hours, and flexible work arrangement options to help you balance your personal and professional life may be available.
  • Professional Development: Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement.
  • Recognition and Rewards: Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events.
  • Community and Culture: A supportive work environment where everyone feels valued, and has a sense of belonging. Participate in team-building activities, volunteer opportunities, and company-sponsored events. Sustainability strategy that outlines our ambitions for how to run our company in a more sustainable way.
  • Competitive Compensation: The starting hourly rate for this position is $26/hr. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives. Actual compensation is influenced by a variety of factors including but not limited to skills, experience, qualifications, and geographic location.
  
  
  
  

Pursuing an ambitious growth agenda, Coloplast develops and markets products and services that make life easier for people with intimate healthcare needs. Employing about 16,000 people and with products available in more than 143 countries, we are one of the world s leading medical device companies. We are constantly growing our business and always looking for new ways to move forward - we explore, learn and look for new ways of doing things.

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Coloplast employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.

Coloplast is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification.

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