Reimbursement Specialist (Bilingual)

Job Function Summary

The Reimbursement Specialist will support Coloplast’s mission to provide a better quality of life for our Chronic Care customers assisting with attaining of our products through the insurance verification process and reimbursement cycle. A successful Reimbursement Specialist uses client information and insurance management knowledge to support consumers to explore and obtain coverage. The Reimbursement Specialist may also assist in providing education and support to our sales teams, clinicians, and additional customers in the areas of both public and private insurance. This positions has a hybrid work arrangement.

Major Areas of Accountability

• Act as an advocate for our customers as it relates to coverage. Liaise with the consumer, insurer and clinician regarding documentation required for maximum reimbursement coverage, including the exploration of all public and private insurers. Proactively update the patient’s file in Salesforce to ensure that reimbursement follow-ups are done in a timely manner. Confirm and enter all insurance information into Salesforce for all intermittent catheterization captures and confirmations.
• Collaborate with Consumer Marketing team to build ongoing lists of user testimonials / ambassadors that speak to the importance of reimbursement and/or success with Coloplast Care’s reimbursement assistance.
• Assist in the education of clinicians, customers, consumers and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines and documentation requirements.
• Work with Market Access and Government Affairs Manager to provide monthly updates to internal stakeholders on the reimbursement submissions, confirmation of coverage and resubmission. The reports may be provided to external customers to indicate the successful level of reimbursement.

• Maintain knowledge of reimbursement programs and payer requirements, guidelines, and policies. Acquire and demonstrate all necessary subject matter expertise, including insurance and product usage.
• Answer incoming calls from customers/patients and about the insurance verification process using appropriate customer service skills.

• Coloplast employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, , and company policies.
• Other job duties as assigned

Basic Qualifications

• Knowledge of both public, government and private reimbursement offerings/insurance plans and their impact on consumers of medical devices is required.
• Bachelor’s Degree or 5+ years’ experience working with reimbursement in Canada.
• Fluently bilingual in English/French
• Ability and willingness to travel nationally as well as internationally (United States). Expected travel is 10%
• Self-driven, pro-active; high-performance and results orientation that can work in a semi-autonomous role. Highly structured approach with attention to detail and proper documentation of all work. Excellent verbal and written communication skills
• Demonstrates both creative and critical thinking skills.
• Prior experience communicating with health care professionals.
• Able to work well in cross-functional teams and also independently.
• Coloplast employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.

Preferred Qualifications

• Knowledge of insurance benefit verification requirements, guidelines and policies, insurance plans requiring pre-authorization