Under the direction of the Director of Access & Reimbursement, the Billing & Reimbursement Manager will support customers to ensure appropriate reimbursement of Tides Medical products. They will be subject matter experts in local payer policies and Tides reimbursement processes. They will be instrumental in the onboarding & training of new customers and sales agents. The Billing & Reimbursement Manager is expected to collaborate with multiple departments at Tides Medical including Sales, Customer Service, Accounting and Commercial Operations.

Essential Functions of the Areas of Responsibility

Perform the following in accordance with AATB, FDA, and Tides Medical stated policies and procedures while upholding Tides Medical’s mission and corporate values.

• New Customer Account Onboarding
• Initiate contact with provider office within 72 hours of product approval
• Provide education of coverage, coding, billing and reimbursement of Tides Medical products
• Track and support the claim submission through final reimbursement process
• Education and Support
• Provide general and patient specific billing & reimbursement questions to customers
• Analyze payor rejections & denials to determine root causes; provide issue resolution to provider offices
• Educate Tides Medical Sales Agents on reimbursement services and payor coverage
• General Responsibilities
• Work with Tides team members to assist customers in resolving reimbursement related issues
• Serve as the payor expert in their assigned geography, tracking trends and communicating policy changes to key customers
• Collaborating with the Tides Reimbursement Hotline staff as needed to resolve patient cases

Expectations

• Work well with others and not create undue office stress or conflicts.
• Be a practical problem solver and work independently.
• Be truthful in all aspects of conduct and communications.
• Be respectful of other employees and not engage in speech or conduct that is discriminatory.
• Participate in scheduled team meetings and calls
• Input activities into customer CRM ( SalesForce) as appropriate
• Uphold confidentiality of employee records, donor records, and proprietary corporate information

• Demonstrated history of working cooperatively in a team environment
• A valid drivers’ license with an insurable [clean] driving record
• A Bachelors degree or 4-7 years of job experience in billing/coding, appeals, patient access, field reimbursement or physician practice management. Certified Professional Biller certification is a plus
• Previous experience in podiatry, dermatology or wound management is preferred
• Previous professional services (CMS 1500) Medicare Part B billing and reimbursement with a working knowledge of CPT, HCPCS, ICD-10 codes, MUEs, NCCI Edits, LCD, etc
• Strong interpersonal and organizational skills; excellent attention to detail and experience coordinating multiple activities.
• A demonstrated ability to analyze payer claim rejections & denials to determine root causes and prevention of future errors.
• Skilled in collaboration and partnership with internal stakeholders
• Proficient at delivering presentations and participate in client meetings as appropriate
• Availability to work 5 days/ 40 hours.

Physical, Mental, Environmental Demands

• Sitting, walking, using a computer, etc.
• Minimal pushing/pulling as in file drawers
• Analyzing and/or other mental requirements
• Speaking on the telephone
• Home Office/work space environment requires quite place to respond to provider offices and present Zoom meetings

• Covid-19 vaccination required, reasonable accommodations as per the ADA are considered.