Field Reimbursement Manager

CoverMyMeds•Omaha, NE

9h•Hybrid

About The Position

McKesson is an impact-driven, Fortune 10 company focused on making quality healthcare more accessible and affordable. They foster a culture of growth, impact, and innovation. The Field Reimbursement Manager (FRM) is responsible for managing an assigned territory, supporting Reimbursement and Patient services by assisting with patient reimbursement challenges for a specific drug. This includes Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals. The FRM also educates physician offices on the Payer landscape and available services through both remote interaction and on-site training. This client-facing and customer-facing role requires building relationships with physician offices and manufacturer representatives to deliver services effectively. The FRM works independently in a fast-paced, highly visible environment, collaborating with internal program hub support services. Frequent telephone interactions with providers and internal staff are required to arrange site visits, manufacturer trainings, and educational venues. A solid working knowledge of Medicare and Commercial insurance plans and benefit structures is essential. The position requires travel, project management, and/or account coordination based on client expectations.

Requirements

4-year degree in related field or equivalent experience
4+ years of healthcare related reimbursement experience
Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
Must have Medicare and commercial insurance coverage experience.
Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis.
Proven presentation skills and experience
Proven ability to effectively handle multiple priorities and excellent organizational skills
Strong Computer literacy to include PowerPoint and Web Meeting experience
Must reside in territory.
Must be able to travel 80% (4 days a week) via automobile or plane.
Must have a valid driver's license with a clean driving record/ MVR

Nice To Haves

Previous field experience, a plus
Previous experience with specialty pharmacy a plus
Account management experience, a plus
Excellent Interpersonal skills.
Excellent written and oral communication skills
Problem solving and decision-making skills

Responsibilities

Provide on-site and on-demand education (including Lunch and Learns or Dinner presentations) for the office staff in regard to Reimbursement challenges and support services that are available.
Office interaction will include education and reimbursement support. On-site/virtual interactions will average 15 per week. These activities are recorded in FRM CRM daily with reporting to manager weekly.
Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams.
Monthly activity reporting captures educational topics at FRM level reportable to client based on client expectation. This trended data is also reported quarterly to client.
Provide Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs.
Collaborate with case manager on average of 4/month and ad hoc as needed for escalations. These interactions are tracked in FRM CRM and hub system.
Responsible for setting up appointments and completing outbound calls to targeted offices.
Assist in completing backlog casework.
Perform additional day-to-day in-office work.
Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.
Track all FRM interactions/activities in FRM CRM which are reportable to management and client.
Monitor program performance for physicians and manufacturer representatives in accordance with expectations.
Territory performance will be monitored via FRM CRM dashboard daily. Trending results will be identified through quarterly reporting. Additionally, clients have the option to survey customers on program performance.
Research and compile provider / manufacturer representative specific information for reimbursement database (Includes account profiles).
Create a facility database on each new provider in FRM CRM. All interactions/activities are built utilizing this database.