Overview:

Job Title: Benefit Investigation Specialist

Reports To: Director, Customer Ops and Reimbursement Support

Department: Customer Operations and Reimbursement Support

Exempt _x___       Non-Exempt ____

Location/Territory: Malvern, PA

Approval/Revision Date: August 2024

Position Overview: (provide a brief description of the general nature of the position)

The Benefit Investigation Specialist is a part of the Operations team and is responsible for completing benefit investigations (BIs) on behalf of our providers, by outlining potential TMS coverage for their patients.  This includes interacting with insurance carriers to research relevant CPT codes, documenting benefit investigation results, and reporting back to the provider’s offices with key information to help patients in need pursue NeuroStar TMS treatment.  The individual will also collaborate with our field Reimbursement team members to help explain benefit information to the patients and providers.  The position also includes the administrative function of logging new Benefit Investigation inquiries as they are requested.  This role includes executing a high volume of work (completing 20-25 benefit investigations daily) as this department relays time sensitive information to the provider’s offices.

Essential Duties/Responsibilities: (describe the major responsibilities that are critical to the role)

Reach out to payers to verify potential patient coverage for providers

Accurately document BI results in CRM platform for delivery to providers

Respond to all inquiries promptly with professionalism and accuracy

Follow all policies and procedures to ensure accuracy and consistency

Resolve all inbound customer BI inquiries and follow through to completion

Problem solve and handle escalated issues appropriately

Work with all Neuronetics field staff to ensure customer satisfaction

Ability to meet all department objectives and metrics for BI completion

Ability to handle high volume efficiently and organize multiple priorities.

Compliance to all department Standard Operating Procedures (SOP’s)

Other Duties as needed or required (include as last item)

Knowledge, Skill, and Abilities: (list skills required to perform the duties and responsibilities of the position)

Aptitude to explain reimbursement language clearly and concisely

Understanding of medical and behavioral health benefit coverage and reimbursement information

Observing trends with specific payers that misquote benefits due to lack of understanding of TMS

Communicating trends with certain payers i.e. best time to call, requiring portal use to obtain benefits, etc

Familiarity with the treatment authorization process and the claim denial and appeals process

Demonstrates excellent oral and written communication skills

Basic computer skills including Microsoft Office, Internet, CRM use, and telephonic systems

Strong problem-solving skills and the ability to identify issues, using sound judgment to escalate when appropriate

Well-developed organizational, interpersonal, and time management skills

Ability to multi-task, work independently and work in a team environment

Education and Experience: (specify the minimum acceptable level of education, experience, and certifications necessary to be able to do the job efficiently)

High School Diploma; GED or equivalent

Associates or Bachelor’s Degree preferred

1-2 years experience in a healthcare setting

Preferred Skills:

1-2 years medical device/healthcare experience, preferably insurance related and working with providers and patients, payers, processing claims & conducting benefit verification calls for medical services using CPT codes

Physical Requirements (what is physically required to perform the daily tasks and job duties?  Be specific.)

Standing 10% / Sitting 90%

Walking/Bending/Stooping 10%

Lifting Requirements 5 to 10 lbs

Travel by air, rail, auto (% of time) – 0%

*Applicants must be authorized to work for any employer in the US. We are unable to sponsor or assume responsibility for employment visa/work authorization at this time. 

Neuronetics is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Neuronetics makes hiring decisions based solely on qualifications, merit, business needs at the time.