Field Reimbursement Manager - W Greenwich RI

Military Spouse Corporate Career Network • West Greenwich, RI

1d • Hybrid

About The Position

In this vital role the Field Reimbursement Manager (FRM) will manage defined accounts within a specified geographic region for Patient Access and Reimbursement. This role involves supporting products by executing the collaborative territory strategic plan. The FRM will ensure an understanding of the reimbursement process, field reimbursement services, and patient support programs. They will also work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI).

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’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
• Experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation or resources.
• Minimum two years of experience in 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
• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers
• Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types
• Strong collaboration 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 less than 10 miles from the geography border

Nice To Haves

• Bachelor's degree in business, healthcare, or a related field
• Experience with specialty/biologic self-injectable (pharmacy benefit) or physician-administered (buy and bill/medical benefit) products
• Advanced knowledge of medical insurance terminology
• Knowledge of Centers of 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

• Act as an extension of the HUB, providing live one-on-one coverage support
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms
• Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges
• Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access
• Coordinate access/reimbursement issues with relevant partners, including the HUB
• Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)
• Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders
• Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution
• Educate offices using approved materials
• Review patient insurance benefit options and alternate funding/financial assistance programs
• Collaborate with other departments to resolve reimbursement issues

Benefits

• health and welfare plans for staff and eligible dependents
• financial plans with opportunities to save towards retirement or other goals
• work/life balance
• career development opportunities
• Flexible work models, including remote and hybrid work arrangements, where possible

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree