Field Reimbursement Manager - New York, NY
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 a collaborative territory strategic plan and helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. The FRM resolves patient-level reimbursement issues and handles patient health information (PHI) when needed. The FRM acts as an extension of the HUB, providing one-on-one coverage support and assistance across the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers on payer coverage, benefit design, formulary requirements, utilization management, insurance procedures, and available patient assistance options. The FRM also coordinates with the HUB and other partners, communicates payer changes to stakeholders, and collaborates across departments to resolve reimbursement issues. The position is primarily remote and work-from-home, with customer appointments in the assigned geography two days per week and one to two home-office days per week. Travel by automobile or plane may be required up to 40%. General office work may involve long periods of sitting and keyboard use.
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.
- In addition to one of the listed education and experience combinations, have experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation. Managerial 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 the pharmaceutical industry in managed care, clinical support, and/or sales.
- Strong medical reimbursement experience and/or knowledge of Specialty Pharmacy and Buy & Bill.
- 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, PowerPoint, and the 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.
- 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 under the pharmacy benefit or physician-administered products under the Buy & 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 & 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 within a specified geographic region for Patient Access and Reimbursement.
- Support products by executing the collaborative territory strategic plan.
- Act as an extension of the HUB by 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 challenges or other issues.
- Educate and update healthcare providers on private and public payer coverage and changes affecting 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 defined geography and promptly communicate payer changes to stakeholders.
- Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigation, prior authorization, 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
