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 available. Responsibilities include educating on various aspects of healthcare reimbursement, managing case work, and collaborating with physicians and manufacturer representatives.

Responsibilities

• Provide on-site and on-demand education for office staff regarding reimbursement challenges and support services.
• Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage, and patient communication streams.
• 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.
• Responsible for setting up appointments and completing outbound calls to targeted offices. Assist in completing backlog casework. Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.
• Maintain program performance for physicians and manufacturer representatives in accordance with expectations. Monitor territory performance via FRM CRM dashboard daily and identify trending results through quarterly reporting. Clients have the option to survey customers on program performance.
• 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, but not limited to insurance verification, prior authorizations, and/or 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, but not limited to insurance verification, prior authorizations, and/or 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. Learn more about our benefits at careers.mckesson.com.