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 address patient reimbursement challenges, including benefit investigations, prior authorizations, claims assistance, and appeals, while educating physician offices about payer landscapes and available services through remote interactions and on-site training. This is a client-facing and customer-facing position that builds relationships with physician offices and manufacturer representatives and delivers services according to customer preferences. The FRM works independently in a fast-paced, highly visible environment and collaborates with internal program hub support services. The role frequently interacts by telephone with providers and internal staff to arrange site visits, manufacturer trainings, and educational venues. A solid working knowledge of Medicare and commercial insurance plans and benefit structures is needed to relay benefit information and support the customer experience. The position includes travel, project management, and/or account coordination based on client expectations. The role is remote, work-from-home, and candidates should be located in Philadelphia, PA, Baltimore, MD, or Wilmington, DE. It requires travel up to 80% (four days a week) by automobile or plane, and residence in the assigned territory.
Requirements
- Four-year degree in a related field or equivalent experience.
- At least four 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 provide regular status reports.
- Proven presentation skills and experience.
- Ability to handle multiple priorities effectively and strong organizational skills.
- Strong computer literacy, including PowerPoint and web meeting experience.
- Excellent interpersonal skills.
- Excellent written 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, including Lunch and Learns or Dinner presentations, to office staff about reimbursement challenges and available support services.
- Conduct an average of 15 on-site or virtual interactions per week; record activities in the FRM CRM daily and report to the manager weekly.
- Educate offices on benefit investigations, prior authorization processes, support center services, Medicare and commercial coverage, and patient communication streams.
- Report educational topics monthly at the FRM level and provide trended data to clients quarterly, as required by client expectations.
- Provide reimbursement support involving case management, billing and coding updates, appropriate claims submission, specialty pharmacy, medical benefit interpretation, medical necessity, claims and appeals assistance, co-pay assistance, and patient assistance programs.
- Collaborate with case managers an average of four times per month and as needed for escalations; track these interactions in the FRM CRM and hub system.
- Set up appointments and complete outbound calls to targeted offices.
- Assist with backlog casework and other day-to-day in-office work.
- Interface with physicians and manufacturer representatives to obtain and provide patient- and provider-specific information.
- Track all interactions and activities in the FRM CRM for reporting to management and clients.
- Monitor program performance for physicians and manufacturer representatives against expectations, using the FRM CRM dashboard and quarterly trend reporting; support optional client customer surveys.
- Research and compile provider- and manufacturer-representative-specific information for the reimbursement database, including account profiles.
- Create a facility database entry in the FRM CRM for each new provider and use the database to support interactions and activities.
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
