Posted: Monday, June 12, 2017 2:13 AM
Nutricia North America, a subsidiary of Danone, is looking for a Reimbursement Care Specialist in the United States for Cedar Knolls, NJ.
Danone is a global food company holding top positions in healthy ood through its four businesses: Fresh Dairy Products, Early Life Nutrition, Waters, and Medical Nutrition. Its mission, bringing health through food to as many people as possible, embodies commitment to human progress and business success. It gives meaning to the work of our 100,000 Danoners worldwide on an everyday basis.
For passionate people looking for autonomy and exciting career opportunities, Danone truly has something special inside.
The Reimbursement Care Specialist works closely with Health Care Professionals, families, insurance companies, state reimbursement program administrators, our field sales organization and the Customer Service team to seek insurance coverage for the metabolic products.
:Understand the landscape of access to our Metabolic portfolio and where limitations exist, works through the process to overcome the challenge.
:Expand coverage of our products in key geographies or with key authorities by:
:Intervening, assisting, managing, and advocating for Metabolic patients coverage of our products with insurance companies and public service programs.
:Navigating the payers system, then informing, counseling, and helping Metabolic patients and their families understand the results.
:Communicating with insurance companies to verify policy information, obtain explanation of benefits, prior authorizations and find in:network providers.
:Assisting medical professionals with health plan prior authorizations and pre:determinations to facilitate authorizations for our products.
:Assisting our customers with coding and billing appeals and support, research and monitor insurance company policies (covered in bullet 1).
:Review patient's Summary Plan Descriptions and insurance contracts to find any and all avenues of opportunities for coverage for our products.
:If unable to find coverage with patient's existing insurance coverage, research for other avenues of coverage, for example, public service programs.
:If unable to obtain coverage through insurance or public service programs, prepare patient case file, including liaising with the patient's dietitian, and propose patient for internal patient assistance program.
:Execute and assist with the implementation of newly structured patient assistance program
:Manage registration of all new Metabolic products with data banks.
:Where possible obtain payer policies such as Medicare, health insurance companies, and coverage requirements by state. Maintain this information in a file on the shared drive.
:Correspond quarterly with special program coordinators, i.e. state programs and develop relationships with the health care providers in the metabolic industry to promote NNA reimbursement care programs
:Maintain a log of the status of all cases, update ACT database, and maintain patient records in accordance with all regulations (e.g., HIPPA).
:Conduct outreach calls to targeted KOLs and highly valued HCPs, offering coverage education and assistance, as needed.
:Assist with the development adult coverage and care program, to include outreach, directing patients to partnering clinics
:Other duties as assigned.
Office environment with limited access to production/warehouse environment. Potential for travel opportunities to interface with customers and assist in coverage of Metabolic Patient Events.
:High school diploma required. Associate/Bachelors degree in Health Information Management or related field preferred.
At least 3 years of experience in the capacity as a Reimbursement Coverage Specialist : working with medical billing and coding and/or insurance eligibility verification and claims.
:1+ years' experience i
• Location: cedar knolls, North Jersey
• Post ID: 37617958 newjersey