Reimbursement Specialist (12Months Contract)

Job Summary

Position Overview:


This position is responsible for providing excellent customer service, responding to customer inquiries, including order placement, reimbursement, shipping status, warranty and general concerns processing for Insulet products. This role is an essential part of the customer management process and will work directly with other team members and departments to ensure that there is strong communication between Insulet, physicians, insurance providers and OmniPod customers.

The Customer Care Specialist, Senior is expected to seek and propose workflow improvements to maximize department efficiency while maintaining an excellent customer experience. (S)he is expected to consistently strive for excellence. The Customer Care Specialist, Senior is a skilled call center and reimbursement professional with a proven track record within the healthcare industry. (S)he is able to perform his/her duties with limited direct supervision. This person would be asked to participate on special projects as (s)he has specialized knowledge and demonstrated success. The Customer Care Specialist, Senior could be called upon to help train other members of the team.

Responsibilities:

This role will provide department support including but not limited to:

• Process all aspects of the order process by verifying insurance benefits to determine eligibility and cost share amounts , reimbursement by contacting payors, verifying insurance benefits and adhering to medical guidelines for reimbursement.
• Serving as a department expert on escalation calls/tasks, Insulet insurance contracts, channeling and processing requirements for all covered products.
• Requesting and collecting updated documentation, order entry and coordinating shipment of product to customers.
• Must maintain a thorough understanding of products offered by Insulet with the ability to explain to potential or existing customers the basic operation and use.
• Answering phone inquiries and providing support and direction to customers and resolving customer service issues in a timely and empathetic manner.
• Submission of all prior authorization requests for approval and payment of Insulet products at time of claim processing.
• Calculate and document cost share amounts for potential customers.
• Collaborate with other commercial teams such as Case Management, OmniPod Sales and Billing, to ensure proactive communication of potential customer’s order status.
• Document all interactions and calls into the customer database and maintain compliance to HIPAA and other regulating bodies as required.
• Provide frequent feedback and suggestions to support an environment of continuous process improvement.
• Using their advanced knowledge and skill set, this position could be called upon to complete a wide range of task within the Reimbursement team.
• Performs other duties as assigned.

Education and Experience:

Minimum Requirements:

• Associates/Bachelor’s Degree and/or equivalent combination of education and experience.
• 4+ years’ related experience in a professional working environment, preferably with extensive phone coverage and medical device or health care oriented.
• Individual health plan insurance knowledge and understanding of the managed care industry is required.
• Knowledge of diabetes and experience supporting patients with diabetes is preferred.
• Experience with Salesforce CRM (preferred).

Preferred Skills and Competencies:

• Fostering Teamwork - The ability and desire to work cooperatively with others on a team.
• Flexibility - Openness to different and new ways of doing things; willingness to modify one's preferred way of doing things.
• Managing Change - The ability to demonstrate support for innovation and for organizational changes needed to improve the organization's effectiveness; initiating, sponsoring, and implementing organizational change; helping others to successfully manage organizational change.
• Diagnostic Information Gathering - The ability to identify the information needed to clarify a situation, seek that information from appropriate sources, and use skillful questioning to draw out the information, when others are reluctant to disclose it.
• Analytical Thinking - The ability to tackle a problem by using a logical, systematic, sequential approach.
• Entrepreneurial Orientation - The ability to look for and seize profitable business opportunities; willingness to take calculated risks to achieve business goals.
• Other Highly Developed Skills / Competencies – Oral Communication, Written Communication, Thoroughness, Stress Management, Technical Expertise, Initiative, Customer Orientation, Interpersonal Awareness, Conceptual Thinking and Self Confidence.

Physical Requirements:

• Requires sitting and standing associated with a normal office environment.
• Manual dexterity needed for using a calculator and computer keyboard.
• Lightweight lifting may be required.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Insulet started in 2000 with an idea and a mission to enable our customers to enjoy simplicity, freedom and healthier lives through the use of our Omnipod® product platform. In the last two decades we have improved the lives of hundreds of thousands of patients by using innovative technology that is wearable, waterproof, and lifestyle accommodating.