Field Reimbursement Manager

About the role

The Field Reimbursement Manager (FRM) is responsible for managing an assigned territory focused on supporting Reimbursement and Patient services by providing assistance with patient reimbursement challenges for a specific drug (including Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training.

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.
• Responsible for setting up appointments and completing outbound calls to targeted offices. Assist in completing backlog casework. Additional day-to-day in-office work. 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.

Requirements

• 4-year degree in related field or equivalent experience
• 4+ years of healthcare related reimbursement 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
• Solid working knowledge of Medicare and commercial insurance plans and benefit structures
• 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
• Previous field experience, a plus
• Previous experience with specialty pharmacy a plus
• Account management experience, a plus
• Excellent Interpersonal skills
• Excellent written and oral communication skills
• Problem solving and decision-making skills

Qualifications

• 4-year degree in related field or equivalent experience
• 4+ years of healthcare related reimbursement experience

Skills

• 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
• Solid working knowledge of Medicare and commercial insurance plans and benefit structures
• 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
• Previous field experience, a plus
• Previous experience with specialty pharmacy a plus
• Account management experience, a plus
• Excellent Interpersonal skills
• Excellent written and oral communication skills
• Problem solving and decision-making skills

Benefits

We not only care about the wellbeing of our patients, customers and the communities we serve — we care about you. That’s why we provide our employees with a comprehensive support system for all aspects of Your Care: physical, emotional, financial and social.