Field Reimbursement Manager

Key Responsibilities

• Provide on-site and on-demand education (including Lunch and Learns or Dinner presentations) for the office staff in regard to Reimbursement challenges and support services that are available.
• Office interaction will include education and reimbursement support. On-site/virtual interactions will average 15 per week. These activities are recorded in FRM CRM daily with reporting to manager weekly.
• Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams.
• Monthly activity reporting captures educational topics at FRM level reportable to client based on client expectation. This trended data is also reported quarterly to client.
• Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs.
• FRM will collaborate with case manager on average of 4/month and ad hoc as needed for escalations. These interactions are tracked in FRM CRM and hub system.
• Absorb and complete backlog casework.
• Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.
• All FRM interactions/activities are tracked in FRM CRM which are reportable to management and client.
• Monitor program performance for physicians and manufacturer representatives in accordance with expectations.
• Territory performance will be monitored via FRM CRM dashboard daily. Trending results will be identified through quarterly reporting. Additionally, clients have the option to survey customers on program performance.
• Research and compile provider / manufacturer representative specific information for reimbursement database. (Includes account profiles)
• FRM will create a facility database on each new provider in FRM CRM. All interactions/activities are built utilizing this database.

  Minimum Job Qualifications

  • 4-year degree in related field or equivalent experience
  • 4+ years of healthcare related reimbursement experience
  • Business Experience – Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
  • Experience supporting oncology products preferred
  • Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
  • Must have Medicare and commercial insurance coverage experience.
  • Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis.
  • Proven presentation skills and experience
  • Proven ability to effectively handle multiple priorities and excellent organizational skills
  • Strong Computer literacy to include PowerPoint and Web Meeting experience