Field Reimbursement Manager

About the role

The Field Reimbursement Manager is responsible for providing on-site and on-demand education to office staff regarding reimbursement challenges and support services. Responsibilities include educating on various aspects of healthcare reimbursement, supporting case management, billing, and coding, and collaborating with case managers and manufacturers.

Responsibilities

• Provide on-site and on-demand education for office staff on reimbursement challenges and support services.
• Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage, and patient communication streams.
• Support 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.
• Set up appointments and complete outbound calls to targeted offices, assist in completing backlog casework, and interface with physicians and manufacturer representatives.
• Maintain program performance for physicians and manufacturer representatives, monitor program performance via FRM CRM dashboard, and identify trends through quarterly reporting.
• Research and compile provider / manufacturer representative specific information for reimbursement 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 in the healthcare industry including insurance verification, prior authorizations, and claim adjudication, physician’s office or clinics
• Medicare and commercial insurance coverage experience
• 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
• Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy
• Experience in the healthcare industry including insurance verification, prior authorizations, and claim adjudication, physician’s office or clinics
• Medicare and commercial insurance coverage experience
• 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

Skills

• 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 provide a comprehensive support system for all aspects of Your Care: physical, emotional, financial, and social. Explore our benefits and join us at McKesson!