Field Reimbursement Manager - New York Metro
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement and supports the Bone Health business unit in the New York City Metro Area. The FRM supports products by executing a collaborative territory strategic plan and helping healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. The role includes resolving patient-level reimbursement issues and requires knowledge and experience handling 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 order through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers about payer coverage and changes, benefit designs, formulary coverage, utilization management, insurance procedures, benefits investigations, and financial assistance options. The FRM serves as a payer expert for the assigned geography and coordinates access and reimbursement issues with the HUB and other internal partners. The role is remote and work from home, with customer appointments in the assigned 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. The position requires a valid driver’s license and a clean driving record; work may involve extended periods of sitting and keyboard use.
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. This 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 knowledge of Specialty Pharmacy and Buy & Bill.
- 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, PowerPoint, and 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 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.
- Strong medical reimbursement experience and/or knowledge of Specialty Pharmacy and Buy & Bill.
- 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, PowerPoint, and web-based meetings.
- Healthcare industry experience, including insurance verification, claim adjudication, physician offices or clinics, pharmacies, and/or pharmaceutical manufacturers.
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 by providing live, one-on-one coverage support.
- Assist healthcare provider offices throughout the reimbursement journey, from physician order through prior authorization, appeals, denials, and claims resolution.
- Review patient-specific information when a site requests help resolving access or coverage issues.
- Educate and update healthcare providers on private and public payer coverage and changes that affect 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 the payer expert for the assigned geography and promptly communicate payer changes to key 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
- Health and welfare plans for staff and eligible dependents.
- Retirement and Savings Plan with generous company contributions.
- Group medical, dental, and vision coverage.
- Life and disability insurance.
- Flexible spending accounts.
- Discretionary annual bonus program, or a sales-based incentive plan for field sales representatives.
- 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
High school or GED
