Lead Reimbursement Specialist

About This Role

As a Lead Reimbursement Specialist, you will empower healthcare providers and patients by ensuring accurate reimbursement guidance for life-changing IVS technologies. You will collaborate with sales and cross-functional teams to solve complex coding and payment challenges.

Responsibilities

• Support reimbursement inquiries from sales teams, providers, and customers by delivering accurate coding, coverage, and payment guidance within established service levels.
• Conduct in-depth research on coding, payer policies, and regulatory updates.
• Review and update coding documents to maintain accuracy of CPT, HCPCS, ICD-9, and ICD-10 assignments.
• Manage all Coding Hotline and email inquiries, tracking and trending contact data.
• Collaborate with providers to research, troubleshoot, and resolve claim issues, including prior authorization, denials, and appeals.
• Coordinate with Sales Representatives to deliver required documentation and ensure customer billing and reimbursement needs are met.
• Develop and deploy payer and provider communications that highlight the value of IVS products and support reimbursement education.
• Provide training, mentorship, and support to new and junior reimbursement team members.

Requirements

• Extensive experience providing coding, coverage, and payment guidance in a healthcare environment.
• Extensive experience supporting prior authorization, denials, and appeals processes.
• Comprehensive knowledge of medical coding guidelines and ability to review operative reports, rejected claims, and EOBs.
• Comprehensive knowledge of Medicare, Medicare Advantage, Medigap, and commercial payer methodologies.

Qualifications

• Bachelor’s degree, or Associate’s degree, or High school diploma/equivalent
• Minimum 4 years of relevant experience with a Bachelor's degree, or 8 years with an Associate's, or 10 years with a High school diploma/equivalent.

Nice to Have

• CPC (Certified Professional Coder)
• CCS-P (Certified Coding Specialist – Physician)

Skills

* Required skills

Benefits