Field Reimbursement Manager- Portland, OR
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 by executing the collaborative territory strategic plan. The role helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs, and works to resolve patient-level reimbursement issues involving protected health information (PHI). The territory covers Oregon, Idaho, Santa Rosa, California, and Redding, California. Relocation is not included. The FRM acts as an extension of the HUB, providing live one-on-one coverage support and assistance across the reimbursement journey, from physician orders through payer prior authorization, appeals, denials, and claims resolution. The position educates healthcare providers on payer coverage, benefit design, insurance procedures, and available patient funding or financial assistance programs. The FRM coordinates with the HUB and other internal partners to address access and reimbursement issues. The role is remote, 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 long periods of sitting and/or keyboard use, and requires a valid driver's license with a clean driving record.
Requirements
- Doctorate degree; or a master's degree and 3 years of customer service and/or leadership experience; or a bachelor's degree and 5 years of customer service and/or leadership experience; or an associate degree and 10 years of customer service and/or leadership experience; or a 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, or programs, or directing resource allocation. This experience may run concurrently with the required technical experience.
- At least 2 years of experience in the 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 meeting tools.
- 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.
- Must be able to travel up to 40% by automobile or plane.
- Must have a 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-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 solve problems.
- Ability to manage expenses within allocated budgets.
Responsibilities
- Manage defined accounts within a specified geographic region for Patient Access and Reimbursement.
- Support the Bone Health business unit by executing the collaborative territory strategic plan.
- Act as an extension of the HUB and provide live, one-on-one coverage support.
- Assist healthcare providers from physician order through reimbursement, including payer prior authorization, appeals, denials, and related requirements and forms.
- Review patient-specific information when a healthcare site requests help resolving coverage challenges or other issues.
- Educate and update healthcare providers about 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 the payer expert for the assigned geography and promptly communicate payer changes to stakeholders.
- Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorization, appeals, and claims resolution.
- Educate healthcare provider offices using approved materials.
- Review patient insurance benefit options and alternate funding or financial assistance programs.
- Collaborate with other departments to resolve reimbursement issues.
Benefits
- Retirement and Savings Plan with company contributions
- Group medical coverage
- Dental coverage
- Vision coverage
- Life insurance
- Disability insurance
- Flexible spending accounts
- Discretionary annual bonus program or, for field sales representatives, a sales-based incentive plan
- Stock-based long-term incentives
- 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
No Education Listed
