Field Reimbursement Manager
About The Position
The CoverMyMeds Field Reimbursement Manager 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, and educates physician offices about payer landscapes and available services through remote interaction and on-site training. This client-facing and customer-facing position builds relationships with physician offices and manufacturer representatives to deliver services according to customer preferences. The manager works independently in a fast-paced, highly visible environment and collaborates with internal program hub support services. The role involves frequent telephone interaction to arrange site visits, manufacturer trainings, and educational venues, and requires working knowledge of Medicare and commercial insurance plans and benefit structures. Travel, project management, and/or account coordination may be required based on client expectations. The manager must reside in the territory covering Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming. The role is remote, work from home, with travel of 20% by automobile or plane.
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, and/or claim adjudication in a physician’s office or clinic.
- Experience with Medicare and commercial insurance coverage.
- Ability to deliver and document benefit investigation outcomes and relay status reports regularly.
- Proven presentation skills and experience.
- Ability to handle multiple priorities effectively and strong organizational skills.
- 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 20% 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; average 15 on-site or virtual interactions per week and document activities daily in the FRM CRM.
- Educate offices on benefit investigation, prior authorization processes, Support Center services, Medicare and commercial coverage, and patient communication streams; contribute to monthly and quarterly client reporting on educational topics.
- Provide reimbursement support for case management, billing and coding updates, appropriate claims submission, specialty pharmacy, medical benefit interpretation, medical necessity, claims and appeals, co-pay assistance, and patient assistance programs.
- Collaborate with case managers an average of four times per month and as needed for escalations, tracking interactions in the FRM CRM and hub system.
- Set up appointments and make 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, and track activities in the FRM CRM for management and client reporting.
- Monitor program performance for physicians and manufacturer representatives against expectations, review territory performance through the FRM CRM dashboard, and identify trends for quarterly reporting.
- Research and compile provider- and manufacturer-representative-specific information for the reimbursement database, create facility databases for new providers in the FRM CRM, and build interactions and activities using these databases.
Benefits
- Competitive compensation package.
- 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
