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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 - $178,000 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 for 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 Web.
- Serve as the primary reimbursement contact for a Regional Sales Team, acting as 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 (PIV).
- Provide payer coverage and reimbursement updates to internal and external customers.
- Follow up with accounts to ensure proper payment of claims, identify reimbursement issues, and work with the account to resolve them.
- Investigate denied or partially paid services and provide guidance on next steps and required support.
- Conduct claim reimbursement reviews to monitor accuracy of payments; provide detailed analysis and identify billing errors.
- Meet or exceed quarterly Metric Based Objectives (MBO) related to education and communication of reimbursement/coverage of MiMedx products.
- Conduct quarterly consignment product audits with Account Executives.
- Report changes in coverage/reimbursement trends and global concerns 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 organizations appeal strategy and manage its ongoing tactical applications to ensure successful reversals where appropriate.
EDUCATION/EXPERIENCE
- Bachelors degree (BS/BA) in a related discipline; 2+ years of buy and bill medical benefit reimbursement experience; 13 years of related field experience preferred.
- Familiarity with medical policy for insurance payers; Medicare, Medicaid, and Commercial insurance (e.g., Aetna, Anthem, Cigna, Humana, UnitedHealthcare).
- Strong understanding of CMS rules and methodologies, multiple places of service requirements, and commercial insurers. Experience with Salesforce-based CRM systems preferred.
- Strong understanding of medical coding (ICD-10, CPT, HCPCS) and health insurance concepts; strong analytical and problem-solving skills.
- Ability to process and interpret complex issues and identify solutions; effective collaboration with internal teams.
SKILLS
- Excellent oral, written, and interpersonal communication skills.
- Ability to interact with all levels of management, third-party payers, and customers.
- Organized, flexible, and able to multi-task with strong attention to detail.
- Strong analytical abilities, clinical interest, and strategic/problem-solving capabilities.
- Ability to influence others to achieve results with tenacity and diplomacy.
- Capable of independent work on larger, moderately complex projects with direct impact on the department.
WORK ENVIRONMENT
- Remote work expectation; travel 23 days per week (approximately 20%30% time) to build solid account relationships.
Time: This role may require travel; compensation includes salary and discretionary bonuses. At MiMedx, we are committed to fair and equitable pay practices. Salary ranges and compensation are determined by a rigorous review process based on experience, education, and location. We offer competitive benefits including healthcare, 401(k), ESPP, vacation, and parental leave.
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. We invite you to apply for the Field Reimbursement Manager role in Boston, MA and join a team focused on impact.
Were also highlighting related opportunities in the area and encourage you to explore roles such as Field Reimbursement Manager Northeast, Field Reimbursement Manager Immunology Dermatology and other positions in the Boston/Central MA region.
Disclaimer: This job description may be updated periodically to reflect business needs.
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