Reimbursement Specialist I

Description :

The Reimbursement Specialist I plays a key role in executing core reimbursement processes to ensure medical necessity is confirmed and accurate payments are secured, helping to reduce the financial impact on patients. This position also contributes to the achievement of Reimbursement Team metrics. Responsibilities include performing in-depth benefit investigations, conducting timely claims follow-up, submitting authorization and referral requests, resolving claim and authorization denials, negotiating single case agreements, and collaborating closely with other teams within Revenue Operations to support overall departmental goals. The ideal candidate demonstrates foundational knowledge of reimbursement workflows and consistently performs assigned tasks with accuracy and timeliness under supervision. A key objective of this role is to contribute to the achievement of Reimbursement Team KPIs, including but not limited to authorization and claim resolution rates.

This is afull-time, non-exemptposition reporting to the Supervisor or Manager of Reimbursement, based in ourPortsmouth, NHoffice.

ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Conduct timely insurance benefit verifications to determine patient eligibility and cost-share responsibilities for both new and existing patients.
• Accurately identify the appropriate "bill-to" insurance party.
• Submit prior authorization requests to insurance carriers and follow up via phone or insurance portals with minimal supervision.
• Interpret authorization denials and draft appeals, when necessary, with limited supervision
• Research and interpret commercial payer medical policies and coverage guidelines.
• Verify the presence and accuracy of authorizations and pricing agreements for all insured patients.
• Differentiate between contract and non-contract carriers, including identifying contacts for potential letter of agreement (LOA) negotiations.
• Escalate contracting implementation challenges and identify opportunities for process improvement.
• Collaborate cross-functionally with other departments to ensure timely and accurate reimbursement from insurance providers.
• Ability to follow up on outstanding insurance balances via phone and insurance website promptly
• Investigate and resolve all incorrect payments and escalate trends in change behavior as identified
• Submit and track the status of claim appeals for payment disputes
• Identify the need for a claims project
• Communicate with key personnel within managed care organizations, such as nurse case managers, to streamline the reimbursement processing for patients
• Perform additional duties and respond to shifting priorities as assigned by management.

QUALIFICATIONS / KNOWLEDGE :

OTHER :

Novocure is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state, or local law. We actively seek qualified candidates who are protected veteran and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

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

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