Insulet Corporation

Case Management Specialist

US-MA-Billerica | US-MA-Billerica
1 week 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 Manager 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 Intake Case Manager 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.
  • Performs other duties and projects as assigned by management.

Education and Experience

  • Associates or Bachelor’s Degree 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

  • Ability to identify and escalate issues requiring management support problem solving.
  • Excellent phone and e-mail communication skills.
  • Strong organization skills and attention to detail.
  • Strong data entry skills; rapid entry of data into customer tracking database while maintaining accuracy.
  • Ability to work in a fast-paced team environment.
  • Experience working in and knowledge of the diabetes industry is preferred.

 

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