Specialist 1, Appeals

GROW WITH US:

Tandem Diabetes Care creates new possibilities for people living with diabetes, their loved ones, and their healthcare providers through a positively different experience. We’d love for you to team up with us to “innovate every day,” put “people first,” and take a “no-shortcuts” approach that has propelled us to become a leader in the diabetes technology industry.

STAY AWESOME:

Tandem Diabetes Care is proud to manufacture and sell the t:slim X2 insulin pump with Control-IQ technology. We’re also so much more than that. Our company’s human-centered approach to design, development, and support delivers innovative products and services for people who use insulin. Since many of our own team members live with type 1 diabetes, or have a loved one impacted by diabetes, the work is personal, and we are committed to the cause. Learn more at tandemdiabetes.com.

A DAY IN THE LIFE:

The Appeals Specialist is responsible for reviewing patient cases in which pre-authorization has been denied. This role will use in depth insurance and Diabetes disease state knowledge to identify and resolve issues in order to gain insurance authorization.

Primary Duties & Responsibilities: 

• Contact potential customers (by phone, secure email, and/or fax) to explain and initiate the appeal process after their initial pre-authorization was denied.
• Maintain up to date knowledge of diabetes disease state and therapies by being well versed in products, programs and alternative therapies from both Tandem Diabetes Care and competitors in order to best support the customer's appeal case.
• Ensure appropriate expectations and updates are communicated to customers throughout the appeals process.
• Manage the relationship with each customer by administering certain aspects of the reimbursement process by:
  • Verifying insurance benefits to determine cost share amounts for prospective customer responsibility, as needed.
  • Collecting all required documentation.
  • Obtaining necessary documents for appeal including creating patient-specific support documents as needed.
  • Upon insurance approval, coordinating shipments of products to customers.
• Assist the Managed Care team in single-case negotiations.
• Collaborate with internal departments and external contacts including provider’s offices and our distribution partners to best support the appeals process. Collaborate with Quality Analyst and training teams to provide feedback regarding how to effectively process insurance authorizations.
• Identifies opportunities for efficiencies in processing authorizations/claims with individual payors; communicates feedback to Appeals Supervisor Document all interactions and calls into the customer relationship management (CRM) system in accordance with QA/RA and HIPAA guidelines in an accurate manner.
• Confirm completion of required training plan before assuming job responsibilities.
• Ensure work is performed in compliance with company policies including Privacy/HIPAA and other regulatory, legal, and safety requirements.
• Additional duties as assigned by management.

YOU’RE AWESOME AT:

Knowledge, skills & abilities:

• Ability to converse in insurance language routinely utilized by the health insurance industry.
• Strong understanding of clinical data related to Diabetes.
• Knowledge of individual health plan insurances’ DME practices.
• Knowledge of Diabetes disease state and related industry product(s) strongly desired.
• Understanding of each stage of the health insurance appeal process.
• Ability to effectively communicate over the phone with customers to resolve issues and answer questions according to department protocols and requirements.
• Excellent written and verbal communication skills.
• Ability to work effectively in a team environment.
• Ability to adjust focus and necessary action as new information is received and situation changes.
• Computer competency including MS office, internet and navigation of Customer Relationship Management (CRM) systems.
• Familiarity with gathering data for reporting metrics is a plus.

Minimum certifications/educational level:

• Bachelor’s degree or equivalent combination of education and applicable job experience.

Minimum experience:

• 1-2 years’ experience working with DME insurance reimbursement.
• Experience documenting calls by typing on a keyboard while speaking to a customer on the phone.

WHAT’S IN IT FOR YOU?

In addition to innovative technology, we have a culture that fosters the idea that the happiest people are the most productive people. Not only do we hire forward-thinking achievers to join our workforce; we reward, develop, and retain them too. Just one of the many reasons of how we #StayAwesome! To learn more about our culture and benefits please visit https://www.tandemdiabetes.com/careers.

BE YOU, WITH US!

Tandem is firmly committed to being an equal opportunity employer and maintaining a diverse and inclusive environment. We value and embrace that every single one of us brings value to the table. But sometimes we forget that when we don’t meet 100% of a job description’s criteria – maybe you’re feeling that way right now? We encourage you to apply anyway. Because we want you to be you, with us.

COMPENSATION & BENEFITS:

The starting base pay range for this position is $22.00 - $24.00 per hour.  Base pay will vary based on job-related knowledge, skills, experience and may also fluctuate depending on candidate’s location and the overall job market. In addition to base pay, Tandem offers a competitive compensation package that includes bonus, equity, and a robust benefits package.

Tandem offers health care benefits such as medical, dental, vision, health savings accounts and flexible saving accounts.  You’ll also receive 10 paid holidays per year, a minimum of 20 days of paid time off (starting in year 1) and have access to a 401k plan with company match.  Learn more about Tandem’s benefits here!

 YOU SHOULD KNOW:

Potential new employees must successfully complete a drug screen (excludes marijuana) and background check which includes criminal search, education certification and employment verification prior to hire. 

REFERRALS:

We love a good referral! If you know someone that would be a great fit for this position, please share!

If you are applying for this job and live in California, please read Tandem’s CCPA Notice: https://www.tandemdiabetes.com/careers/california-consumer-privacy-act-notice-for-job-applicants.

SPONSORSHIP:

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

LI-Remote #LI-CM1

Salary : $22 - $24