Field Reimbursement Manager - Oklahoma City, OK
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement. The role supports products by executing the collaborative territory strategic plan and helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. The FRM also resolves patient-level reimbursement issues and works with patient health information (PHI). The FRM acts as an extension of the HUB and provides live, one-on-one coverage support throughout the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers about private and public payer coverage, benefit design, formulary coverage, utilization management criteria, and changes affecting patient access. The manager coordinates access and reimbursement issues with the HUB and other partners, reviews insurance benefit options and financial assistance programs, and collaborates across departments to resolve reimbursement challenges. This position covers Oklahoma. It is remote/work from home, with customer appointments in the geography two days per week and one to two home-office days per week. Travel of up to 40% by automobile or plane is required. Relocation is not included.
Requirements
- Meet one of the following education and experience combinations: doctorate degree; master's degree and 3 years of customer service and/or leadership experience; bachelor's degree and 5 years of customer service and/or leadership experience; associate's degree and 10 years of customer service and/or leadership experience; or high school diploma/GED and 12 years of customer service and/or leadership experience.
- Experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation. This experience may be concurrent with the required technical experience.
- At least 2 years of experience in a public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales.
- Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge.
- Proven presentation and facilitation skills.
- Strong written and oral communication skills.
- Organizational skills and project management experience, including the ability to manage multiple projects.
- Strong computer literacy, including Word, Excel, and PowerPoint, and ability to conduct web-based meetings.
- Healthcare industry experience, including insurance verification, claim adjudication, physician offices or clinics, pharmacies, and/or pharmaceutical manufacturers.
- Experience with HUBs and in-depth knowledge of billing, coding, and appeals issues across physician types.
- Strong collaboration skills and ability to lead cross-functional partner meetings.
- Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region.
- Live in the geography or within 10 miles of its border.
- Must have a valid driver's license with a clean driving record.
- Must be able to travel up to 40% by automobile or plane.
Nice To Haves
- Bachelor's degree in business, healthcare, or a related field.
- 6 years of experience with specialty/biologic self-injectable products (pharmacy benefit) or physician-administered products (Buy & Bill/medical benefit).
- Advanced knowledge of medical insurance terminology.
- Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part B for Buy & Bill products and Part D for pharmacy products.
- Ability to manage ambiguity and solve problems.
- Ability to manage expenses within allocated budgets.
Responsibilities
- Manage defined accounts within a specified geographic region for Patient Access and Reimbursement.
- Execute the collaborative territory strategic plan in support of products.
- Act as an extension of the HUB, providing live one-on-one coverage support.
- Assist healthcare providers throughout the reimbursement journey, including prior authorizations, appeals, denials, required forms, and claims resolution.
- Review patient-specific information when a site requests help resolving coverage challenges or other issues.
- Educate and update healthcare providers on private and public payer coverage and changes that affect patient access.
- Coordinate access and reimbursement issues with relevant partners, including the HUB.
- Explain product coverage under commercial, Medicare, and Medicaid benefit designs.
- Serve as a payer expert for the defined geography and promptly communicate payer changes to stakeholders.
- Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorizations, appeals, and claims resolution.
- Educate healthcare provider offices using approved materials.
- Review patient insurance benefit options and alternative funding or financial assistance programs.
- Collaborate with other departments to resolve reimbursement issues.
Benefits
- Retirement and Savings Plan with generous company contributions
- Group medical coverage
- Dental coverage
- Vision coverage
- Life insurance
- Disability insurance
- Flexible spending accounts
- Discretionary annual bonus program or, for field sales representatives, a sales-based incentive plan
- Stock-based long-term incentives
- Award-winning time-off plans
- Career development opportunities
- Flexible work models where possible
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
