Field Reimbursement Manager
About The Position
The CoverMyMeds Field Reimbursement Manager (FRM) manages an assigned territory and supports reimbursement and patient services for a specific drug. The role helps physician offices address patient reimbursement challenges, including benefit investigations, prior authorizations, claims assistance, and appeals, and educates office staff about payer landscapes and available services through remote interactions and on-site training. This client- and customer-facing position requires building relationships with physician offices and manufacturer representatives, tailoring service delivery to customer preferences, and working independently in a fast-paced, highly visible environment while collaborating with internal program hub support services. The FRM frequently communicates by telephone with providers and internal staff to arrange site visits, manufacturer trainings, and educational events. The role requires working knowledge of Medicare and commercial insurance plans and benefit structures, and may involve travel, project management, and account coordination based on client expectations. The position is remote, work-from-home, but requires residence in the assigned territory and travel up to 80% (four days per week) by automobile or plane.
Requirements
- Four-year degree in a related field or equivalent experience.
- At least 4 years of healthcare-related reimbursement experience.
- Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
- Healthcare industry experience, including insurance verification, prior authorizations, claims adjudication, or work in a physician's office or clinic.
- Experience with Medicare and commercial insurance coverage.
- Ability to deliver and document benefit investigation outcomes and relay status reports regularly.
- Proven presentation skills and experience.
- Ability to handle multiple priorities effectively, with excellent organizational skills.
- Strong computer literacy, including PowerPoint and web meeting experience.
- Excellent interpersonal, written communication, and oral communication skills.
- Problem-solving and decision-making skills.
- Must reside in the assigned territory.
- Must be able to travel 80% (four days a week) by automobile or plane.
- Must have a valid driver's license and a clean driving record/MVR.
Nice To Haves
- Previous field experience.
- Previous experience with specialty pharmacy.
- Account management experience.
Responsibilities
- Provide on-site and on-demand education to office staff about reimbursement challenges and available support services, including Lunch and Learns or dinner presentations; average 15 on-site or virtual interactions per week and record activities in FRM CRM daily.
- Educate offices on benefit investigations, prior authorization processes, Support Center services, Medicare and commercial coverage, and patient communication streams; document educational topics for monthly and quarterly client reporting.
- Provide reimbursement support for case management, billing and coding updates, claims submission, specialty pharmacy, medical benefit interpretation, medical necessity, claims and appeals, co-pay assistance, and patient assistance programs.
- Collaborate with case managers approximately four times per month and as needed for escalations, tracking interactions in FRM CRM and the hub system.
- Set up appointments, make outbound calls to targeted offices, assist with backlog casework, and complete additional day-to-day office work.
- Interface with physicians and manufacturer representatives to obtain and provide patient- and provider-specific information.
- Track all interactions and activities in FRM CRM for management and client reporting.
- Monitor program performance for physicians and manufacturer representatives using the FRM CRM dashboard and identify trends for quarterly reporting.
- Research and compile provider- and manufacturer representative-specific reimbursement information, create facility databases for new providers in FRM CRM, and use those databases to build interaction records.
Benefits
- Competitive compensation package.
- An annual bonus or long-term incentive opportunities may be offered.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
