Field Reimbursement Manager - New York, NY
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement and supports products by executing the collaborative territory strategic plan. The FRM helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs, and works to resolve patient-level reimbursement issues involving protected health information (PHI). The role 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 FRM educates healthcare providers about public and private payer coverage, benefit design, utilization management, insurance procedures, benefits investigation, and financial assistance options. The position coordinates access and reimbursement matters with the HUB and other internal partners, serves as a payer expert for its geography, and communicates payer changes to stakeholders. The position includes customer appointments in the assigned geography two days per week and one to two home-office days per week. It is described as remote/work from home with geographic travel, and requires travel of up to 40% by automobile or plane. General office demands include possible extended periods of sitting and keyboard work. A valid driver's license and clean driving record are required.
Requirements
- 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 run concurrently 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 ability to manage multiple projects.
- Computer literacy, including Word, Excel, PowerPoint, and web-based meetings.
- Healthcare industry experience, such as 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 across physician types.
- Ability to collaborate and 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 and 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-and-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 to support products.
- Act as an extension of the HUB and provide live one-on-one coverage support.
- Assist healthcare providers throughout the reimbursement journey, including prior authorization, appeals, denials, and claims resolution.
- Review patient-specific information when a site requests help resolving coverage challenges or other issues.
- Educate and update healthcare providers on public and private payer coverage and changes that affect patient access.
- Coordinate access and reimbursement issues with the HUB and relevant partners.
- Explain product coverage under commercial, Medicare, and Medicaid benefit designs.
- Serve as a payer expert for the assigned geography and promptly communicate payer changes to stakeholders.
- Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigation, prior authorization, 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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
