Field Reimbursement Manager - Hartford, CT
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. It also involves resolving patient-level reimbursement issues and handling patient health information (PHI). The FRM serves as an extension of the HUB, providing live one-on-one coverage support and assistance throughout the reimbursement journey, from physician orders through payer prior authorization, appeals, and denials. The manager reviews patient-specific cases when sites request help with coverage challenges; educates healthcare providers on public and private payer coverage, benefit design, and payer changes; coordinates issues with the HUB and other partners; and provides office education using approved materials. The role also reviews insurance benefit options and financial assistance programs, and collaborates across departments to resolve reimbursement issues. The role is based in the specified geography, with remote work from a home office and customer appointments in the geography. Travel of up to 40% by automobile or plane is required.
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.
- Have experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation.
- 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.
- Proven 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 and 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' experience with specialty/biologic self-injectable products under the pharmacy benefit or physician-administered products under the 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.
- 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.
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 by providing live one-on-one coverage support.
- Assist with reimbursement from physician order through prior authorization, appeals, and denial requirements and forms.
- Review patient-specific information when a site requests help resolving issues or coverage challenges.
- Educate and update healthcare providers on public and private payer coverage 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 a payer expert for the defined geography and 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 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
