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.
• 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.
• Collaborate with case manager on average of 4/month and ad hoc as needed for escalations.
• Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.
• Maintain and update 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
• Solid working knowledge of Medicare and Commercial insurance plans and benefit structures

Qualifications

• Business 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.
• 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

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

Travel Requirements

• Looking for candidates in the following states: IL, NY, MI, FL, OH, MA, PA, VA, TX, TN, GA, NC, AZ, NV, CA, CO, MN
• Bilingual candidate needed in Miami, FL
• Must reside in territory.
• Must be able to travel 80% (4 days a week) via automobile or plane.
• Must have a valid driver's license with a clean driving record/ MVR

Pay

$76,300 - $127,100

Schedule

Not specified