Reimbursement Specialist - Healthcare jobs in Pittsburgh, PA

At ZOLL, we're passionate about improving patient outcomes and helping save lives.

We provide innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and treat patients suffering from serious cardiopulmonary and respiratory conditions.

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.

Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives.

ZOLL has been Pittsburgh's Manufacturer of the Year, one of Western PA's Healthiest Employers, and even one of Pittsburgh's Coolest Offices. But it's our unique opportunity to impact people's lives that makes ZOLL the ideal place to build your career.

Job Summary

The position will be responsible for the coordination and growth of our reimbursement initiatives. To be successful in this position, person must be able to handle both the tactical level (i.e. help RSM's and providers with denials, billing education etc.) as well as understand and contact payers on a higher level of reimbursement discussions. The person we are looking for must be able to work independently, be proactive and creative and know his way in the reimbursement regulatory maze. You will work closely and in coordination with our sales organization, leadership team and Regional Sales Managers, as well as other field professionals. It reports into the VP Strategic Planning & Health Economics.

Essential Functions

• Understand and follow reimbursement guidelines and policies to include timely updates and communicate changes that affect reimbursement to management.
• Must be able to read policies, understand our device and technology and how our device is reimbursed.
• Must be able to contact payors (insurance companies) to increase reimbursement amounts.
• Keep track of payers’ policies and if they accept our products.
• Monitor and analyze payer’s policies and provide published data to company relevant staff. Provide data in order to address reimbursement challenges, such as usage volumes, number of covered lives etc..
• Contact and negotiate with insurance company to handle denials as well as policy issues.
• Point of contact for field agents (RSMs) and others when they need to understand coverage issues, or once they encounter a reimbursement problem.
• Lead the reimbursement efforts on the Tactical level.
• Address denials (why and how to solve).
• Educate providers (what to do to be reimbursed).
• Provide timely and effective solutions aligned with company needs

Required/Preferred Education and Experience

• BS Degree in health-related or similar field Preferred
• 5 years of reimbursement or comparable experience Required and
• Experience and knowledge of sleep regulations helpful, (AASM, CMS, Etc.)
  Required and
• Proven experience dealing with insurance companies and payors Required and
• Experience in Cardiovascular or Sleep Apnea required
  Required and
• Experience with reimbursement of medical devices Preferred and
• Experience in working with specific tools monitoring payers’ policies such as Canary Insights or others.
  Required
• Professional Coding Certification Required

Knowledge, Skills and Abilities

• Proven negotiating and customer relationship management skills with the ability to navigate a complex process.
• Ability to effectively manage assigned accounts in terms of problem resolution and business planning.
• Proven effective verbal, computer, written and presentation/communication skills.
• Ability to quickly adapt and respond to job, environmental, and industry changes.
• Strong customer service skills, with excellent written & verbal communication skills.
• Strong analytical skills.
• Must be able to communicate always effectively & maintain professional conduct.
• Organized, self-starter with the ability to handle numerous projects and prioritize workload with minimal supervision.

Travel Requirements

• 10% Travel up to 10%

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  
  • The employee is required to sit – perhaps at long intervals of time
  • The employee is required to work on computer for long intervals
  • The employee is required to talk on the phone for long intervals

ZOLL is a fast-growing company that operates in more than 140 countries around the world. Our employees are inspired by a commitment to make a difference in patients' lives, and our culture values innovation, self-motivation and an entrepreneurial spirit. Join us in our efforts to improve outcomes for underserved patients suffering from critical cardiopulmonary conditions and help save more lives.