Company Description

Who we are 

At Tobii Dynavox, we empower people with disabilities to do what they once did or never thought possible. We call this mission Power to Be You. Our assistive communication technology helps our customers express themselves, connect with the world, and pursue independence, whether through everyday activities like ordering food or extraordinary feats like running a company. Working at Tobii Dynavox, you’ll become part of a team that spans the globe, with offices in the US, Sweden, the UK, China, and beyond.  

To learn more about what we make possible, meet some of our customers or take a look at some of our products. 

Job Description

What you’ll do 

Tobii Dynavox is seeking an Appeals Specialist to assist the growing Healthcare Policy and Contracting department. The Appeals Specialist researches, reviews, and responds to member and/or provider appeal issues in accordance with departmental policies and procedures, and outside regulatory agency requirements. Serves as a resource for internal and external questions related to member and provider appeal issues, including identifying needed system changes and contacting other areas to implement those changes.

Case Management

• Maintaining communication with SLPs on funded cases and instruct SLPs on document preparation and funding policies and regulations
• Working with insurance providers, government agencies, and educational institutions to place new product, repair or rental orders
• Tracking funding authorization cases ensuring requests are resolved to completion in a timely manner
• Utilizing on-line resources and maintain frequent communication with funding agencies to verify eligibility
• Reviewing prior authorization documents against third party payer criteria
• Researching previous orders and payment history/DSOs for any repair or new order requests Enter and complete orders in the order management system database
• Serving as a client advocate by communicating with clients and family members on funding requests and co-payment requirements, representing client’s case with third party insurance providers and troubleshooting any problems to resolution
• Resolving third party denials and provide consultation to finalize difficult funding cases
• Alerting supervisor of potential third party payer challenges Perform various other duties as assigned

Appeals

• Reviews and evaluates appeal requests and inquiries in order to identify and classify member and provider appeals.
• Using internal systems, determines eligibility, benefits, and prior activity related to the claims payment or service denial issues related to appeal requests.
• Completes cases within State and Commercial payer timeframes.
• Utilizes the appropriate systems and resources to communicate, in writing, findings, decisions, rationale for denial or approval and follow-up on corrective action as requested.
• Identifies and requests internal/external documentation as needed for medical necessity appeal issues and submit cases to appropriate area for review.
• Facilitates processing of appeal to independent review organization (IRO)
• Serves as a resource/training for appeals unit staff and as a resource for internal/external questions related to appeals processing issues.
• Researches, responds and makes recommendations for possible resolution to issues.
• Reviews complex and sensitive cases. Researches and replies to executive inquiries.
• Contacts customer or provider by phone for additional information or clarification. Follows up with written correspondence.
• Attends meetings and/or participates in special projects as needed.
• Monitors and tracks payer denial trends and reports applicable information to internal and external department staff.
• Performs other duties as assigned.

Qualifications

Education & Experience:

• Bachelor’s Degree or 3-5 years equivalent experience    
• 3+ years third party payer experience
• Knowledge of DME Billing and Prior Authorizations

Competencies, Knowledge, and Skills: 

• Technical writing skills
• Intermediate level skills in Microsoft Word & Excel with Access skills a plus
• Communication skills (written, oral and interpersonal)
• Multitasking ability
• Able to work independently and within a team environment
• Familiarity of the Healthcare field
• Knowledge of Medicaid
• Time Management
• Decision-making and/or problem solving skills
• Proper grammar skills
• Phone etiquette skills

Physical:

• Communication skills using the spoken word
• Ability to see within normal parameters
• Ability to hear within normal range
• Ability to move about

Work Environment:

• Ability to work with interruptions
• Thrive in a fast paced work setting

Additional Information

Please address your questions to Jesse Rosenthal at Jesse.Rosenthal@tobiidynavox.com or submit your resume through our website as soon as possible. Don't wait! At Tobii, we move quickly!

Tobii Dynavox values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Tobii Dynavox does not discriminate against individuals on the basis of race, color, sex, sexual orientation, gender identity, religion, disability, age, veteran status, ancestry, or national or ethnic origin.

Equal Opportunity Employer/AA Women/Minorities/Veterans/Disabled