Reimbursement Specialist

Job Description

Job Description

Element Science, Inc. is a medical device and digital health company focused on developing solutions at the intersection of clinical-grade wearables, machine learning algorithms, and lifesaving therapies in order to address leading causes of death and hospitalization in patients with heart disease, primarily as they transition from the hospital-to-home. By putting the needs of patients and physicians first, our personalized digital devices, which are designed for function, comfort, and ease-of-use, aim to redefine the paradigm of care for these patients. Our first product, a wearable patch defibrillator, is initially targeted at treating the more than 500,000 patients in the US with an elevated temporary risk of potentially experiencing a lethal heart rhythm. Headquartered in San Francisco, our funders include Third Rock Ventures, Google Ventures, Deerfield Healthcare, Qiming Venture Partners USA, Cormorant Asset Management, and Invus Opportunities.

SUMMARY OF ROLE:

As a Reimbursement Specialist, you play a vital role in ensuring patients have access to the care they need while supporting the financial health of the organization. You'll be at the forefront of the order-to-cash process, verifying insurance coverage, assessing medical necessity, and securing prior authorizations with accuracy and efficiency. This role is ideal for someone who thrives in a fast-paced, mission-driven environment and takes pride in removing barriers to care while enabling timely order fulfillment and reimbursement.

RESPONSIBILITIES:

• Gather all necessary documentation, as it relates to payer requirements, standard operating procedures, and compliance programs to be able to bill the insurance payer on record
• Thoroughly review submitted clinical documentation and compare to payers' medical policy to determine if the service will be covered
• Provide clear and detailed communicate to Field team and/or providers if additional information is required to have a valid order or to ensure insurance coverage
• Utilize web portals and/or phone to verify patients' insurance including eligibility, benefits (coinsurance, deductible, max out of pocket) and calculate patients estimated out of pocket
• Confirm prior authorization requirements and submit via web portal, fax or phone as applicable
• Draft single case agreements for out of network payers to secure in network benefits for patients
• Handle both inbound and outbound phone calls from/to patients with questions regarding their out-of-pocket costs and/or financial assistance qualifications
• Complete billing checklist to ensure first pass claims submissions
• Maintain accurate and detailed notes as it pertains to all aspects of the Reimbursement processes within NikoHealth
• Monthly update of patients' benefits, demographic and insurance information as needed
• Confirm new prescribers' qualifications to order including NPI, PECOS enrollment and OIG status and add to billing and clinical systems
• Maintain a strong knowledge of guidelines related to HIPAA, OIG Compliance, medical coding, and billing/reimbursement
• Assist Sales and other departments to resolve billing issues
• Provide exceptional customer service to patients and providers through friendly, caring, informative, and professional interactions
• Perform other duties as assigned by management

QUALIFICATIONS:

• 3-5 years prior experience in a Reimbursement role in healthcare, medical device or DME responsible for benefits, eligibility and prior authorizations
• Associate's degree or equivalent professional experience
• Minimum of 1 year calculating and communicating financial estimates to patients
• Knowledgeable medical terminology including HCPCS and ICD-10 coding
• Possession of one or more prestigious certifications such as Certified Professional Coder (CPC), Certified Professional Coder Hospital (CPCH), Certified Coding Specialist (CCS), or Certified Outpatient Coder (COC) a plus
• Demonstrated excellence in customer service delivery
• Exceptional capacity for follow-through, organization, and meticulous attention to detail.
• Ability to prioritize and work in a fast-paced environment

BENEFITS:

Element Science offers a very competitive salary and benefits package including, but not limited to:

• Stock Options
• 90% employer-paid medical, dental, and vision insurance
• Company-paid Basic Life Insurance
• 401(k) retirement plan (Traditional and Roth)
• Competitive Paid Time Off
• Paid Holidays
• FSA (Flexible Spending Accounts)
• HSA (Health Savings Account)
• Employee Assistance Program through PEO

The salary for this exempt-level position will be based on experience and qualifications within an established pay range.

• Pay range: $60,000 - $70,000

Element Science is an Equal Opportunity Employer. All candidates will be evaluated on the basis of their qualifications for the job in question. We do not base our employment decision on an employee's or applicant's race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors prohibited by local, state, or federal law.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. We are not able to sponsor individuals for employment visas for this job.

At this time, we are unable to offer relocation assistance at Element Science.