Job details

Reimbursement Case Advocate

The Reimbursement Case Advocate (RCA) is responsible for supporting various reimbursement functions, including but not limited to Intake, Data Entry, Benefit Investigations, Call Triage, Prior Authorizations, Pre-Determinations, and Appeals support. The Reimbursement Case Advocate (RCA) responds to all provider account, patient, and internal inquiries in a timely fashion. The Reimbursement Case Advocate (RCA) will appropriately document all interactions with provider, payer and related customers into the Osiris Database system.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Acts as single point of contact and voice for all providers, patients and product / sales team.
Serves as a patient advocate and enhances the collaborative relationship between, payer, provider and sales team.
Initiates and coordinates the insurance verification for physicians, hospitals, and ambulatory surgery centers for all company products.
Performs a detailed insurance verification for all product and applicable procedures to the degree authorized by the SOP of the program.
Manages a regional case load.
Provide assistance to physician office staff to complete and submit all necessary insurance forms and gather missing information in a timely manner.
Tracks and follows-up on prior authorization and appeal requests when necessary.
Provides all necessary documentation required to expedite prior authorization requests including demographic, authorization/referrals, National Provider Identification (NPI) number and referring physicians.
Accurately records all reimbursement correspondence and research in the database per the assigned fields and required metrics.
Analyzes data and draws valid and logical conclusions based on information provided by insurers and documented medical policies.
Communicates insurance verification, prior authorization, and denied claim results to customers and answers all related questions.
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
Prioritizes duties and tasks as necessary to ensure assignments are completed in a timely fashion. Reports any reimbursement trends/delays to Team Lead.
Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action.

EDUCATION

Bachelor's degree preferred.

QUALIFICATIONS

Previous coding and billing experience in the office, hospital, or ASC settings Experience in a reimbursement-based call center environment preferred.
1-3 years customer service, reimbursement experience preferred Knowledge of Medicare, Medicaid, and Private Insurer Reimbursement Methodology
Experience with the prior authorization process for products/services

COMPETENCIES

Able to interpret and analyze detailed medical policies Basic understanding of the benefits investigation process [deductible, out of pocket, benefits exclusions, etc.]
Ability to communicate effectively both orally and in writing.
Adept at handling sensitive and confidential situations

LOCATION

US-Field

Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.

Smith & Nephew Glassdoor Company Review

4.1

Smith & Nephew DE&I Review

No rating

CEO of Smith & Nephew

Deepak Nath

Approve of CEO

By Smith & Nephew

Physical health is never just about our body. It’s our mind, feelings and ambitions. When something holds it back, it’s our whole life on hold. We’re here to change that, to use technology to take the limits off living, and help other medical pro...

15 jobs

MATCH

Calculating your matching score...

FUNDING

Public

INDUSTRY

Health Care Products Manufacturing

TEAM SIZE

10000+

LOCATION

Hybrid, based in Watford, United Kingdom

DATE POSTED