The Reimbursement Operations Coordinator (formerly Commercial Patient Advocate) plays a vital role in supporting the daily operations of the Prior Authorization and Appeals teams. This position is responsible for facilitating timely and accurate communication with payers to follow up on the status and outcomes of prior authorizations and appeals. In addition, the coordinator will serve as a liaison with patients, helping them understand the appeals process and ensuring all required documentation is completed and submitted. Key responsibilities include managing incoming and outgoing correspondence related to authorizations and denials, maintaining accurate records through tracking reports and internal systems, and ensuring smooth workflow across the department. The coordinator will also assist with processing cases, organizing documentation, and contributing to continuous process improvements. The role is full time, exempt and will work remotely.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
● Communicate with payers to follow up on statuses of prior authorizations or appeals
● Communicate with the team members about authorization and appeal statuses
● Submit additional information to payers if needed for processing of authorization or appeal requests
● Process approvals and denials accurately in salesforce
● Explain appeal process to patients and obtain additional information needed for appeals such as personal attestation letters or payer specific forms
● Communicate with clinician offices to obtain medical records, required documentation and signatures that are needed to assist with the authorization and appeal processes
● Assist the department with dispersing correspondence
● Maintain a high level of accuracy while meeting productivity and quality requirements
● Support other departments to ensure accurate processing of patient orders and payer approvals and denials
● Identify trends for process improvement and communicate to leadership
● Assist in the development of internal processes and best practices for the reimbursement operations department
● Benefit and authorization process investigation
● Follow all compliance and HIPAA requirements
● Other duties as assigned
Minimum Qualifications Education, Experience and Training
● High school diploma or equivalent, Associate’s or Bachelor’s degree a plus
● Previous experience in the medical device industry, healthcare reimbursement or related field
Knowledge, Skills and Abilities
● Excellent written and verbal communication skills
● Excellent problem solving and analytical skills
● Ability to produce grammatically accurate authorization, appeal and patient correspondence
● High attention to detail
● Ability to work under pressure and deliver complete, accurate, and timely results
● Proven ability to work independently, multitask, prioritize and meet required deadlines
● Ability to be persuasive and credible with payers
● Working knowledge and expertise of insurance processes
● Technology savvy and able to navigate payer portal systems
● Ability to work independently and in collaboration with a team
● Able to provide clear and concise communication to payers, field reps, clinicians, peers and management via phone, email, video conference and/or in person
Core Competencies
● Communication & cultural competence
● Initiative & critical thinking
● Flexibility & adaptability
● Planning & organization
● Teamwork & collaboration
Tools and Technology
Google suite, Adobe, Salesforce CRM
Physical Functions and Work Environment
The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
Note
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
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