Reimbursement Specialist

Life Unlimited. At Smith+Nephew, we design and manufacture technology that takes the limits off living.

This role supports the company in achieving its mission to connect patients, providers, and payors to ensure patients can access outstanding technologies and products.

The Reimbursement Specialist verifies patient benefits for incoming insurance verification requests, responds to verification related inquiries, and reports patient coverage based on payer coverage criteria and reimbursement information to the requesting healthcare provider.

Additionally, the selected candidate will be responsible to provide outstanding customer service support for all outbound provider communication, inbound calls, and case issues while adhering to company policies, procedures, and compliance directives always. This role will be required to ensure all protected health information (PHI) is handled appropriately within the governing Health Insurance Portability and Accountability Act (HIPAA) guidelines.

What will you be doing?

• Performs a detailed insurance benefit verification for all products including acquiring patient responsibility, researching payer coverage criteria, and any required prior authorization requirements.
• Maintain clear documentation of all tasks, review reports for accuracy and completeness, prepare and send insurance benefit verification results to healthcare providers, and protect PHI, all within the departments required timeline.
• Reports any payer delays/reporting challenges and raises complaints accordingly to Team Lead and/or Supervisor.
• Collaborates with Market Access and Patient Access Reimbursement Manager (PARM) teams to further investigate reporting issues or change in payer coverage criteria.
• Performs related duties as assigned.

What will you need to be successful?

• Work experience or education in a healthcare related, life sciences, or quantitative field (Medicine, Nursing, Biology, Biochemistry, Engineering, Math, Finance/Accounting, or related).
• Four-year college degree preferred.
• Reimbursement and/or Healthcare admissions/Intake experience within the healthcare industry.
• 2 or more years of customer service, healthcare admissions/intake, and/or reimbursement experience within the biotechnology, pharmaceutical or Durable Medical Equipment (DME) industry, or related field
• Basic knowledge of Medicare, Medicaid, and Private Insurance Reimbursement Methodology
• Able to interpret and analyze detailed medical policies and coverage criteria
• Understanding of the patient's benefits verification process including health plan benefit structure (coverage, deductible, out of pocket, benefits exclusions, etc.)
• Prior experience working for a medical or pharmaceutical reimbursement hub or hotline
• Previous coding and billing experience in the healthcare industry - preferred, but not required
• Intermediate knowledge of Microsoft based products/Office Suite (Word, Excel, Outlook, TEAMS, etc.)
• Basic understanding of Data Entry/Customer Relationship Management programs (Salesforce, Dynamics365, other)
• Familiar with ICD 10 Coding.

The anticipated base compensation range for this position is $24.20 - $36.22 USD Hourly. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, geographical location, and internal equity. It is not typical for an individual to be hired at the high end of the range for their role at Smith + Nephew. Compensation decisions are dependent upon the facts and circumstances of each position and candidate.

To be considered for this role, please submit your application by June 19, 2025

You. Unlimited.

We believe in creating the greatest good for society. Our strongest investments are in our people and the patients we serve.

• Inclusion, Diversity and Equity- Committed to Welcoming, Celebrating and Thriving on Diversity, Learn more about Employee Inclusion Groups on our website (https://www.smith-nephew.com/ ).
• Your Future: 401k Matching Program, 401k Plus Program, Discounted Stock Options, Tuition Reimbursement
• Work/Life Balance: Flexible Personal/Vacation Time Off, Paid Holidays, Flex Holidays, Paid Community Service Day
• Your Wellbeing: Medical, Dental, Vision, Health Savings Account (Employer Contribution of $500+ annually), Employee Assistance Program, Parental Leave, Fertility and Adoption Assistance Program
• Flexibility: Hybrid Work Model (For most professional roles)
• Training: Hands-On, Team-Customized, Mentorship
• Extra Perks: Discounts on fitness clubs, travel and more!

Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.