Field Reimbursement Manager (Southern California)

About the role

The Field Reimbursement Manager (FRM) is a contracted, client-facing role responsible for managing a dedicated territory to support access for providers and patients. This highly visible position involves educating healthcare providers and office staff on access services and reimbursement solutions specific to a product and therapeutic area. The FRM will execute a regional or territorial strategic plan in partnership with internal and external stakeholders, including call center services (HUB), sales, market access, and other matrix field partners.

The role requires handling patient-level reimbursement issue resolution, including access to and experience with patient health information (PHI), while adhering to compliance and defined Rules of Engagement. The FRM will demonstrate a consultative approach to help offices obtain insurance authorization and reimbursement for appropriate patients, directly impacting a positive experience for both healthcare providers and patients.

Responsibilities

• Manage daily activities supporting appropriate patient access to client products in provider offices and act as a liaison to other patient assistance and access support services (e.g., HUB, Call Center, Specialty Pharmacy Services).
• Serve as an extension of the client’s HUB, providing in-person customer visits as appropriate.
• Participate in client meetings, team meetings, and calls, and input call activity into the customer CRM.
• Act as a payer expert for a defined geography, communicating payer changes to key stakeholders in a timely manner.
• Provide office education and awareness throughout the access process, including formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution.
• Educate offices using approved client-provided materials and review specific patient case information in a compliant manner.
• Train physician office staff on the use of client patient support services, including web-based provider portals.

Requirements

• 3+ years of experience in one or more of the following: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management.
• 4-year degree in a related field or equivalent experience.
• Ability to travel 3-4 days a week, including overnights and flights as needed; must reside within the territory.
• Solution-oriented mindset with strong business acumen and analytic capabilities.
• Experience with specialty/biologic products and/or complex reimbursement processes.
• Demonstrated ability to educate offices on access processes and issue resolution.
• Experience educating healthcare providers on client-specific Patient Service programs (e.g., copay, nurse education, bridge, patient assistance).
• Experience delivering educational presentations in person and via technology platforms (e.g., Zoom, Webex, Teams).
• Advanced knowledge of medical insurance terminology and Centers for Medicare & Medicaid Services (CMS) policies, with expertise in Medicare (Part B for buy & bill products and Part D for Pharmacy products).
• Ability to manage ambiguity, problem-solve, and prepare/submit expense reports in a timely fashion.
• Valid Driver’s License.