Commercial Reimbursement Specialist I

JOB SUMMARY:

The Commercial Reimbursement Specialist I, is responsible for following core reimbursement processes to ensure the accurate completion of eligibility and benefit verification, reviewing insurance medical policies and submitting initial authorization submission as well as authorization follow-ups. Additionally, the Commercial Reimbursement Specialist I, will submit re-authorizations and administrative authorization appeals when needed. This position supports the core reimbursement processes to minimize the financial burden for our patients. This position will require collaborating with and supporting the other Revenue Operations functional teams.

This is a full-time, non-exempt position reporting to the Supervisor, Reimbursement and it is based in our Portsmouth, NH office. This role operates on a hybrid schedule: (Monday, Thursdays on-site, Tuesday, Wednesday, Friday remote).

Essential Duties & Responsibilities:

• Basic knowledge of how to perform timely insurance benefit verifications to determine eligibility and cost-share amount for new and existing patients.
• Basic knowledge on understanding who the responsible "bill-to" insurance party is
• Basic knowledge on how to submit authorization requests to insurance carriers
• Ability to follow-up on insurance authorization requests via phone and insurance website in a timely manner with minimal supervision
• Ability to interpret an authorization denial and draft an appeal if needed
• Ability to research and understand commercial payers medical policies and guidelines for coverage
• Verify presence of and accuracy of authorizations and pricing agreements for all patients with insurance
• Ability to distinguish the needs between contract carriers and non-contract carriers, including obtaining a contact for letter of agreement negotiations
• Identify and escalate contracting implementation challenges and opportunities
• Work as part of the larger support team, collaborating with other departments to ensure timely accurate payments from insurance companies
• Perform all other duties or priorities assigned by management as needed

Qualifications/Knowledge:

• Associates degree or equivalent experience preferred
• 0-2 years experience in a reimbursement-related function, DME-specific experience preferred
• Familiarity with medical policies and payer contracts preferred

• Familiarity with basic medical and insurance terminology preferred
• Familiarity with Microsoft Office and SAP preferred

• Maintain integrity and tenacity while working accounts
• Ability to understand and escalate difficult situations
• Ability to collaborate with key internal and external teams
• Ability to solve problems and set priorities
• Ability to work independently with minimal supervision
• Ability to work efficiently and cooperatively in a fast-paced office setting

• Fundamental written and verbal communication skills with internal and external customers
• Fundamental customer service skills

• Ability to lift 20 pounds

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

- innovation

- focus

- drive

- courage

- trust

- empathy

An Equal Opportunity Employer, including disability/veterans

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