Field Reimbursement Manager - Miami, FL
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement, supporting the Bone Health business unit. The FRM executes a collaborative territory strategic plan and helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. The role includes resolving patient-level reimbursement issues and handling patient health information (PHI) when needed. The position covers the Greater Miami area; relocation is not included. The FRM acts as an extension of the HUB and provides live, one-on-one coverage support throughout the reimbursement journey, from physician orders through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers about payer coverage, benefit design, formulary criteria, utilization management, insurance procedures, benefits investigation, and financial assistance options. The FRM also serves as a regional payer expert, communicates coverage changes to stakeholders, and collaborates with internal partners to resolve access and reimbursement issues. This is a remote, work-from-home role with 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. The work may involve prolonged sitting and keyboard use, and a valid driver's license with a clean driving record is required.
Requirements
- Doctorate degree; or master's degree and 3 years of customer service and/or leadership experience; or bachelor's degree and 5 years of customer service and/or leadership experience; or associate 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.
- In addition to one of the listed education and experience combinations, 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.
- Computer literacy, including Word, Excel, PowerPoint, and web-based meetings.
- Healthcare industry experience, including 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.
- 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 assigned geography or within 10 miles of its border.
- Ability to travel up to 40% by automobile or plane.
- Valid driver's license with a clean driving record.
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 problem-solve.
- Ability to manage expenses within allocated budgets.
Responsibilities
- Manage defined accounts in an assigned geographic region for Patient Access and Reimbursement.
- Execute the collaborative territory strategic plan in support of products.
- Support understanding of reimbursement processes, field reimbursement services, and patient support programs.
- Resolve patient-level reimbursement issues, including cases involving patient health information when a site requests assistance.
- Act as an extension of the HUB and provide live, one-on-one coverage support.
- Support the reimbursement journey from physician order through prior authorization, appeals, denials, and claims resolution.
- Educate and update healthcare providers on private and public payer coverage changes that affect patient 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 assigned geography and promptly communicate payer changes to stakeholders.
- Educate offices on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution using approved materials.
- Review patient insurance benefit options and alternate funding or financial assistance programs.
- Collaborate with other departments and cross-functional partners to resolve reimbursement issues.
- Travel to customer appointments within the territory as required.
Benefits
- 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 a sales-based incentive plan for field sales representatives
- 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
