POSITION SUMMARY: 

To develop and implement procedures to effectively increase revenue through the appeal process. 

DUTIES AND RESPONSIBILITIES (essential functions of position): 

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

·         Develop reports to analyze and measure effectiveness and results of appeal procedures. 

·         Educate third party payers, government agencies and private payers about Orthofix products and services. 

·         Utilize payer knowledge and experience to develop an effective appeal packet template. 

·         Analyze patient’s medical file in conjunction with payer knowledge to effectively pursue approval. 

·         Determine resolution alternatives and inform management. 

·         Recommend write-offs to management for approval. 

·         Train Reimbursement personnel on appeal procedures.

·         Work closely with National Account Manager on coordinating ongoing contact with payers.

·         Negotiate and persuade third party payer to reimburse for the Company’s product through effectively appealing.

·         Initiate and coordinate efforts with National Account Managers those opportunities for changing medical policy that have a negative impact on our business and to include third party payer contracting opportunities. 

·         Develop reports to effectively analyze results of the appeals process. 

·         Coordinate preparation of appeal packets and medical policy presentation packages. 

·         Track progress with appeals in revenue gained.

·         Develop and monitor basic and advanced training programs for Sales Administration personnel.

·         Coordinate the appeal procedures training and follow up activities associated with Sales Administration personnel.    

·         Select and prepare other faculty for assistance in training and development needs.

·         Regular attendance required.

ESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS: 

·         Ability to effectively interact with National Accounts, Sales and Clinical departments and as well as Third Party payers.  

·         Technical competency and presentation skills are essential. 

·         Expertise with Reimbursement process and appeals.

·         Ability to present and articulate effectively to individuals on all levels.

·         Insurance and Medical terminology a must.

·         Ability to prioritize work assignments and meet deadlines.

·         In-depth knowledge of anatomy, product and related clinical studies.

·         Innovative thinker with excellent judgment, analytical and decision-making skills.

·         Ability to track revenue results.

·         Bachelor of Science degree or equivalent work experience required.

NONESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS (not necessary but preferred):

·         N/A

SUPERVISORY RESPONSIBILITIES:

·         N/A

PHYSICAL DEMANDS AND WORK CONDITIONS:

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.

·         Regularly required to sit for extended periods of time; frequently required to stand, walk and use business equipment daily such as P.C., copier, fax, telephone, etc.; occasionally required to reach overhead, bend, and lift objects of up to 30 lbs.

·         Eyesight and hearing must be correctable to standard level.

·         Ability to deal effectively with specific elements of the position, such as: frequently changing deadlines, periodic heavy workloads, and dynamic business growth.

·         Minimal travel required up to 15%.

Please apply online directly at:

http://hostedjobs.openhire.com/epostings/submit.cfm?fuseaction=app.dspjob&jobid=303985&company_id=15578&jobboardid=24