Insulet Corporation

Case Management Specialist (Monday-Friday 10:30am-7pm)

US-MA-Billerica | US-MA-Billerica
14 hours ago
Category
Customer Care / Customer Support

Position Summary

The primary responsibility of this role is to review and process clinical documentation promptly and accurately to ensure proper reimbursement from contracted payors.  This role will work with all department functions, and must have a thorough understanding of the reimbursement process, clinical guidelines and medical policies.

 

The Case Management Specialist is able to independently follow standardized workflows as defined by management. This is a skilled position that requires customer service and/or healthcare reimbursement experience and the ability to apply acquired skills to ensure the insurance claim is processed correctly and the company is able to successfully collect. The Case Management Specialist will be expected to work on a broad range of tasks including some more complex situations.

Responsibilities

  • Initiate and follow through on the collection of medical documentation needed to process authorization requests.
  • Review and process all clinical documentation, ensuring accuracy and adherence to medical policies prior to authorization submission.
  • Review all patient case files prior to order creation to ensure quality and accuracy, document corrective actions and escalate as appropriate.
  • Review all orders prior to release of shipments.
  • Document all interactions and calls into the customer database and maintain compliance to HIPAA and other regulating bodies as required.
  • Collaborate with other members of the commercial team such as OmniPod Sales, Reimbursement and Billing to ensure proactive communication of potential customer’s order status.
  • Provide frequent feedback and suggestions to support an environment of continuous process improvement.
  • Additional projects as assigned.
  • Perform other duties as required.

Education and Experience

  • Associates or Bachelor’s Degree (preferred) and/or equivalent combination of education and experience.
  • 2-3 years’ related experience in a professional working environment, preferably with extensive phone coverage and medical device or health care oriented.
  • Individual health plan insurance knowledge and understanding of the managed care industry is required.
    Bilingual skills a plus.
     

Skills/Competencies:

  • Oral Communication - The ability to express oneself clearly in conversations and interactions with others.
  • Written Communication - The ability to express oneself clearly in business writing.
  • Fostering Teamwork - The ability and desire to work cooperatively with others on a team.
  • Thoroughness - Ensuring that one's own and others' work and information are complete and accurate; following up with others to ensure that agreements and commitments have been fulfilled.
  • Ability to maintain composure and function effectively while working in a fast-paced environment.  
  • Ability to multi-task and handle several problems or tasks at once through effective time management and organization skills.  
  • Ability to identify and escalate issues requiring management support.
  • Technical Expertise - Demonstrating depth of knowledge and skill using standard business / office technology and applications.
  • Other Skills / Competencies – Flexibility, Diagnostic Information Gathering, Analytical Thinking, Initiative, Self Confidence and Customer orientation.
     

Physical Requirements:

  • Requires sitting and standing associated with a normal office environment.
  • Manual dexterity needed for using a calculator and computer keyboard.
  • Lightweight lifting may be required.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
     

 

 

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