Reimbursement Specialist II

About Dexcom:
Founded in 1999, Dexcom, Inc. provides continuous glucose monitoring technology to help patients and their clinicians better manage diabetes. Since our inception, we have focused on better outcomes for patients, caregivers, and clinicians by delivering solutions for people with diabetes - while empowering our community to take control of diabetes.
The Reimbursement Specialist II will act as a reimbursement resource to customers and sales team. This position is also responsible for supporting customer service functions. This position is directly involved in the communication and processing of claims and addressing all reimbursement related questions and concerns. Communication on customer status to the sales force is an important role of this position.
Essential Duties and Responsibilities:
Manage and track all stages of the claims process for non-contracted and contracted payors:
Proactively follow up on claim status, re-billing, recalculations.
Review Explanation of Benefits statements and take appropriate action via verbal or written appeal to challenge short/zero paid claims and various denials.
Ensures claims are paid according to contractual agreements.
Demonstrate proven knowledge and technical skills to perform insurance follow-up with positive financial results to include accuracy, timeliness, and attention to detail.
Answer incoming calls and electronic mail regarding insurance inquiries
Work closely with Finance/Accounts Receivables to keep customers accounts' current.
Maintain high level of integrity and confidentiality / patient privacy (HIPAA). All information (written, verbal, electronic, etc.) that an employee encounters while working in a reimbursement environment is always confidential.
Support Patient Billing department staff with payor and customer related questions and issues.
Serve as a reimbursement resource for internal (sales force) and external customers (customers, payors, physicians, sales team).
Generate monthly reports as required by department or payor contract
Deliver superior frontline customer service to the satisfaction of End Users and Health Care Professionals to ensure positive outcomes and impact on future sales.
Work in conjunction with Patient Billing staff, Supervisor, and Manager to execute actions plans and objectives to support internal and external clients.
Remain current on third-party coverage, reimbursement information, trends, ICD-9, ICD-10, and HCPCS
Monitor payer policy activities on technology coverage and payment.
Assume and perform other duties as assigned.
Required Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Effective written and verbal communication skills. Planning, documentation and organization skills. Able to independently problem-solve; effective multi-tasking ability; attention to detail; excellent computer and telephone skills; time management skills - ability to prioritize, ability to work in a demanding, fast-paced environment; high level of energy, motivation and flexibility. Flexibility in a start-up environment to work outside of set job responsibilities
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Preferred Qualifications:
2+ years of billing experience with medical billing and/or insurance collections preferred. Proven knowledge of and experience with ICD-9, HCPCS, and modifier coding. Outstanding interpersonal, verbal, and written communications skills required. Must be flexible and able to work in a fast-paced, heavy volume work environment. Demonstrated computer, prioritization, and time management skills. Experience working at insurance companies/payors or with medical device reimbursement for a start-up or new technology company or durable medical equipment setting is high desirable.
Education Requirements:
High school diploma or general education degree GED. Familiar with medical device reimbursement from a manufacturer or DME perspective
Travel Required:
0 €“ 24%
Language Skills:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write, read, and interpret routine reports and correspondence, frequently medical in nature. Ability to speak effectively over the phone and before groups of customers or employees of the organization
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.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. May be exposed to the following environmental conditions: Wet or humid conditions, work near moving parts, work in high - precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, extreme heat (non-weather), extreme cold (non-weather), risk of electric shock, work with explosives, risk of radiation, vibration. The noise level in this work environment can range from quiet to very loud.
Please note: The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor are they intended to be an all-inclusive list of the skills and abilities required to do the job. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time. The duties and responsibilities in this job description may be subject to change at any time due to reasonable accommodation or other reasons.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled

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