Reimbursement Specialist II - Collections

Description :

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.

ESSENTIAL DUTIES AND 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.

QUALIFICATIONS / KNOWLEDGE :

OTHER :

ABOUT NOVOCURE : Our vision

Patient-forward : aspiring to make a difference in cancer.

Our patient-forward mission

Together with our patients, we strive to extend survival in some of the most aggressive forms of cancer by developing and commercializing our innovative therapy.

Our patient-forward values

Novocure is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state, or local law. We actively seek qualified candidates who are protected veteran and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

Novocure is committed to providing an interview process that is inclusive of our applicant's needs. If you are an individual with a disability and would like to request an accommodation, please email NovocureRecruitingEEO@novocure.com

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