The power to provide patients a life without limitations starts here
Össur operates a network of Clinics across the United States. As a leading global company in non-invasive orthopedics, Össur along with Össur Patient Care, delivers advanced and innovative technologies within the fields of prosthetics, braces, supports and compression therapy.
Job Summary
Applies expertise in professional area to achieve results. Responsible for managing ongoing education of local compliance representatives to ensure they meet the company standards related to documentation requirements. Prepares, logs, and processes Health Insurance audit requests, appeals and grievances. Responsible for conducting pertinent research to evaluate, respond to, and close appeals. Organizes, and prepares materials and information relating to audit requests and processes appeals for all lines of business.
Responsibilities
Exercises sound judgment to determine delivery feasibility & reimbursement potential of device types sent for review.
Performs secondary documentation reviews for compliance representatives going through “Green Light” Training.
Acts as point of contact for compliance-related inquiries and delivery decision assistance for all clinic staff.
Manages appeal requests - prepares and responds or escalates within designated time requirements.
Assists with payer audit request responses both pre-pay and post-pay, for designated entities.
Conducts research, evaluates, responds to, and completes appeals and other inquiries properly.
Prepares appeal summaries and correspondence for review. Documents information for tracking/trending data.
Maintains system of tracking for audit and appeal responses
Identifies trends and communicates this information to relevant stakeholders
Presents reimbursement information in a diplomatic and persuasive manner based on Payer requirements
Elevates complex appeals to supervisor per protocol Utilizes Secondary Green Light Reviews as training opportunities for Compliance Standards and Best Practices for compliance representatives.
Education and Experience
Vocational degree from accredited institution.
Minimum 2 years work experience in healthcare environment in billing and/or operations.
Embla Medical is committed to sustainable business practices and renowned for positively impacting people‘s health and well-being
Embla Medical is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available individual in every job.
Embla Medical's equal opportunity policy prohibits all discrimination (based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical disability, mental disability, military service, pregnancy, child birth or related medical condition, actual or perceived sexual orientation, or any other consideration made unlawful by local laws around the world).
Embla Medical is committed to complying with all applicable laws providing equal employment opportunities. This commitment applies to all individuals involved in the operations of Embla Medical and prohibits discrimination by any employee of Embla Medical, including supervisors and co-workers.
Important Warning: Beware of fraudulent recruiters impersonating our company. Please take extra caution when asked for any sensitive personal information, such as social security numbers or bank account details. We will never ask you for any form of payment during the recruitment process. Please make sure you refer to our official website.
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