Field Reimbursement Manager- Cleveland, Ohio
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement, supporting the Bone Health business unit. 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, requiring knowledge and experience with patient health information (PHI). The FRM acts as an extension of the HUB, providing live, one-on-one coverage support and assistance throughout the reimbursement journey—from physician orders and payer prior authorization to appeals, denials, and claims resolution. The role educates healthcare providers on public and private payer coverage, benefit design, coverage changes, formulary criteria, utilization management, insurance procedures, and patient assistance options. The manager reviews patient-specific information when assistance is requested, coordinates access and reimbursement issues with relevant partners, serves as a payer expert for the geography, and collaborates across departments to resolve issues. The territory covers Cleveland, Akron, and Toledo, Ohio, and Fort Wayne, Indiana. The position 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.
- In addition to the applicable education and experience combination, have experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation; managerial experience may run concurrently with the required technical experience.
- At least 2 years of experience in a public or private third-party access arena or the 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 and project management experience, including the ability to manage multiple projects.
- Strong computer literacy, including Word, Excel, and PowerPoint, and the 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.
- Valid driver's license with a clean driving record.
- Ability 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 (pharmacy benefit) or physician-administered (buy and bill/medical benefit) products.
- 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-and-bill products and Part D for pharmacy products.
- Ability to manage ambiguity and problem-solve.
- Ability to manage expenses within allocated budgets.
Responsibilities
- Manage defined accounts within a specified geographic region for Patient Access and Reimbursement.
- Support products by executing the collaborative territory strategic plan.
- Act as an extension of the HUB and provide live one-on-one coverage support.
- Assist healthcare providers from physician order through reimbursement, including payer prior authorization, appeals, denials, and required forms.
- Review patient-specific information when a site requests assistance resolving issues or coverage challenges.
- Educate and update healthcare providers on private and public payer coverage and changes affecting patient product 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 communicate payer changes promptly to stakeholders.
- Provide office education on formulary coverage, utilization-management criteria, insurance forms and procedures, benefits investigations, prior authorizations, appeals, and claims resolution.
- Educate offices using approved materials.
- Review patient insurance benefit options and alternate 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
- Work/life balance plans
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
