Field Reimbursement Manager - Miami, FL
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts in the Greater Miami area for Patient Access and Reimbursement, supporting products by executing a collaborative territory strategic plan. The FRM helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs, and resolves patient-level reimbursement issues using patient health information when needed. The FRM acts as an extension of the HUB and provides one-on-one coverage support throughout the reimbursement journey, from physician orders and payer prior authorization through appeals, denials, and claims resolution. The role educates healthcare providers on payer coverage, benefit designs, formulary and utilization management criteria, insurance procedures, and changes that affect patient access. It also reviews patient benefit options and funding assistance programs, coordinates issues with the HUB and other partners, and collaborates across departments to resolve reimbursement challenges. The territory covers the Greater Miami area, and the employee must live in the geography or within 10 miles of its border. The work arrangement includes remote work from a home office, customer appointments in the territory 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; associate's degree and 10 years; or high school diploma/GED and 12 years.
- 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 allocation of resources. 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 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 involving 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 the geography 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.
- Six years of experience with specialty/biologic self-injectable pharmacy-benefit products or physician-administered buy-and-bill/medical-benefit products.
- Advanced knowledge of medical insurance terminology.
- Knowledge of Centers for Medicare & Medicaid Services 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 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 involving 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, providing live one-on-one coverage support.
- Assist healthcare providers from physician order through reimbursement, including prior authorization, appeals, denials, and related requirements and forms.
- Review patient-specific information when a site requests help resolving coverage or access challenges.
- 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 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 healthcare provider offices using approved materials.
- Review patient insurance benefit options and alternative 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 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.
- Flexible work models where possible.
- Career development opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
