Field Reimbursement Manager - California

Davita Inc.; Anaheim (CA); Remote; USD 106,000 - 157,000; Full time

Job summary

A leading company in healthcare is seeking a Field Reimbursement Manager to support a regional sales team in navigating patient access and reimbursement for its products. The role involves educating customers on reimbursement processes, ensuring accurate claim payments, and maintaining compliance with industry regulations. Candidates should have a strong background in reimbursement strategies, analytical skills, and excellent communication abilities. This position offers a competitive salary and the opportunity to make a significant impact in the healthcare field.

Benefits

Healthcare

401k savings plan

Vacation

Parental leave

Qualifications

• 2+ years of buy and bill medical benefit reimbursement experience.
• Familiarity with medical policy for insurance payers.
• Certification is required in some areas.

Responsibilities

• Conduct training on billing, coding, and reimbursement processes.
• Serve as the primary reimbursement contact for sales teams.
• Troubleshoot payer reimbursement issues.

Skills

Analytical skills

Interpersonal communication

Problem-solving

Organizational skills

Education

BS/BA in related discipline

MS/MA in related field (optional)

Tools

Salesforce based CRM systems

Job description

Description

At MIMEDX, our purpose starts with helping humans heal. We are driven by discovering and developing regenerative biologics utilizing human placental tissue to provide breakthrough therapies addressing the unmet medical needs for patients across multiple areas of healthcare. Possessing a strong portfolio of industry leading advanced wound care & surgical products combined with a promising clinical pipeline, we are committed to making a transformative impact on the lives of patients we serve globally.

We are excited to add a Field Reimbursement Manager to our reimbursement team! The position will pay between $106,000 - $157,000 plus bonus based on previous relevant experience, educational credentials, and location.

POSITION 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.

ESSENTIAL DUTIES AND 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's appeal strategy and manage its on-going tactical application to ensure a successful reversal rate

EDUCATION/EXPERIENCE:

• 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/COMPETENCIES:

• 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

WORK ENVIRONMENT:

• The work is typically performed at home. Will be required to travel 2-3 days a week a few weeks per quarter to build solid account relationships (20% to 30% of time).

At MIMEDX, we are committed to fair and equitable pay practices. We pay our employees equitably for their work, commensurate with their individual skills and experience. Salary ranges and additional compensation, including discretionary bonuses and incentive pay, are determined by a rigorous review process. Salary ranges consider the experience, education, certifications, and skills required for the specific role, equity with similarly situated employees, as well as employer-verified US region specific market data provided by an independent 3^rdparty partner. Individual salaries vary depending on factors such as your experience, education, location and special skill set. In addition, MIMEDX offers competitive benefits including healthcare, 401k savings plan, ESPP, vacation, and parental leave.

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to, or requirements for, this job at any time.

Qualifications

Education

Bachelors (required)

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.