Reimbursement Specialist II

Novocure•Portsmouth, NH

61d•Onsite

About The Position

The Reimbursement Specialist II is responsible for executing core reimbursement processes to confirm medical necessity and secure accurate payments, thereby minimizing the financial burden for patients. This role requires independently managing a personal workload, including performing in-depth benefit investigations, conducting timely claims follow-up, submitting authorization and referral requests, resolving claim and authorization denials, and negotiating single case agreements. The Reimbursement Specialist II also collaborates closely with cross-functional teams within Revenue Operations to support departmental goals and ensure seamless reimbursement operations. A key objective of this role is to contribute to the achievement of Reimbursement Team KPIs, including but not limited to authorization and claim resolution rates. This is a full-time, non-exempt position reporting to the Supervisor or Manager of Reimbursement, based in our Portsmouth, NH location.

Requirements

Bachelor's degree or equivalent experience preferred
3 - 5 years' experience in a reimbursement-related function, DME-specific experience preferred
Readiness to take on additional responsibilities and seek successful outcomes
Demonstrated excellence in meeting and exceeding customer expectations
Maintain integrity and tenacity while working accounts
Ability to effectively de-escalate and resolve difficult situations
Proven written and verbal communication skills with internal and external customers
Ability to work independently with limited supervision
Ability to work efficiently and cooperatively in a fast-paced office setting
Demonstrated knowledge of medical and insurance terminology required
Demonstrated effectiveness in communicating with insurance companies about medical policies and contracts required
In-depth knowledge of Microsoft Office and SAP preferred
Ability to lift up to 20 pounds

Responsibilities

Conduct timely insurance benefit verifications to determine patient eligibility and cost-share responsibilities for both new and existing patients.
Ensure the responsible "bill-to" insurance party is set up correctly in each assigned account
Submit authorization requests to insurance carriers and follow up via phone or insurance portals independently with limited supervision
Interpret authorization denials and draft appeals, leveraging all available resources, independently
Research and understand commercial payers' medical policies and guidelines for coverage
Verify the presence and accuracy of authorizations and pricing agreements for all insured patients.
Differentiate between contract and non-contract carriers, including identifying contacts for potential letter of agreement (LOA) negotiations.
Escalate contracting implementation challenges and identify opportunities for process improvement.
Collaborate cross-functionally with other departments to ensure timely and accurate reimbursement from insurance providers.
Investigate and resolve all incorrect payments and escalate trends in change behavior as identified
Submit and track the status of claim appeals for payment disputes
Identify, report, and work to resolve the need for a claims project
Communicate with key personnel within managed care organizations, such as nurse case managers, to streamline the reimbursement processing for patients
Identify and escalate contracting implementation challenges and opportunities
Identify and suggest solutions to authorization processing issues based on payer policies and/or behavior
Perform additional duties and respond to shifting priorities as assigned by management.
Identify new trends in authorization denials by payer.
Independently follow-up on insurance authorization requests and claim status via phone and insurance website in a timely manner.