Senior Reimbursement Specialist

POSITION SUMMARY:

The Senior Reimbursement Specialist plays a key role in supporting appropriate and timely reimbursement for the Vivistim implant and associated paired rehabilitation therapy. Working under the guidance of the Reimbursement Manager and VP of Market Access & Reimbursement, this role assists in claim submission, denial management, and payer-related inquiries. The Specialist will collaborate with provider and facility financial services teams, revenue integrity staff, and the field sales team to help resolve reimbursement issues, research payer policies, and support appeals.

Depending on experience and expertise, the Senior Reimbursement Specialist may take on more complex payer interactions, assist with training initiatives, and contribute to strategic reimbursement projects. Both levels of the role support payer engagement efforts, track policy changes, and contribute to the development of reimbursement-related materials such as billing guides, training presentations, and budget impact tools. As a key contributor to the Market Access & Reimbursement team, this individual will provide administrative and tactical support to reimbursement programs, driving process efficiencies and improving patient access to Vivistim therapy.

POSITION RESPONSIBILITIES / ESSENTIAL FUNCTIONS:

• Assist in claim submission, denial management, and reimbursement-related troubleshooting to ensure accurate and timely payments.
• Support hospitals, rehabilitation clinics, and revenue integrity teams in navigating reimbursement processes, including claim corrections and appeals.
• Work closely with the Reimbursement Manager to research payer policies, identify coverage challenges, and assist in resolving reimbursement barriers.
• Help develop and maintain reimbursement-related materials, including billing guides, training slide decks, presentations, and budget impact tools/calculators.
• Provide support for payer outreach efforts, including gathering necessary documentation for coverage reviews and policy considerations.
• Respond to provider and facility inquiries regarding payer medical policies, prior authorization requirements, claim denials, and appeals processes.
• Collaborate with the field sales team, providing reimbursement insights and supporting their efforts in addressing access challenges at healthcare facilities.
• Monitor payer trends and policy updates, ensuring internal teams are informed of changes that may impact reimbursement.
• Maintain accurate records of all communications with providers, payers, sales teams, and internal stakeholders.
• Ensure accuracy of coding and billing by supporting the review of CPT, HCPCS, and ICD-10 codes and reimbursement guidelines.
• Support internal reimbursement projects and initiatives to improve processes and optimize access to Vivistim therapy.
• Other duties as assigned.

POSITIONAL COMPETENCIES

• Teamwork – Works collaboratively with internal teams, providers, and sales representatives to support reimbursement efforts.
• Integrity – Handles confidential and sensitive information with professionalism, ensuring compliance with HIPAA and company policies.
• Adaptability & Innovation – Quickly adjusts to evolving business needs and payer policies, assisting in problem-solving efforts to improve reimbursement success.
• Attention to Detail – Ensures accuracy in claims tracking, documentation, and reimbursement materials to support providers and internal teams.

QUALIFICATIONS:

• Senior Reimbursement Specialist: Minimum 5 years of progressive experience in reimbursement, claims processing, payer policy navigation, and appeals.
• AAPC Certified Outpatient Coder (COC) or equivalent certification (CPC, CCS, or similar) preferred.
• Education: Minimum Bachelor’s degree required; Associate’s degree with relevant experience may be considered.
• Familiarity with hospital charging and billing practices, including CPT, HCPCS, ICD-10 coding, and billing modifiers.
• Knowledge of Medicare and Commercial claims submission, billing, and appeals, with the ability to review and interpret explanation of benefits (EOBs) and remittance advice (RA) documents.
• Experience with both professional (CMS-1500) and facility (UB-04/CMS-1450) billing preferred.
• Strong attention to detail, organizational skills, and ability to manage multiple tasks in a fast-paced environment.
• Preferred Qualifications:
• Experience with Salesforce®, EPIC Systems®, or other EHR/ERP systems.
• Prior experience supporting a medical device reimbursement team is a plus.

MicroTransponder provides a comprehensive benefits program to employees.  It includes medical, dental and vision plans along with an FSA.  Employees may participate in the company 401(k) plan with company matching.  The company offers an unlimited Paid Time Off (PTO) program and approximately 15 paid company holidays per year.