Field Reimbursement Manager - Hartford, CT

Military Spouse Corporate Career Network•Hartford, CT

4d•Remote

About The Position

The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement and supports products by executing the collaborative territory strategic plan. The FRM helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs, and resolves patient-level reimbursement issues using patient health information when needed. The role provides live, one-on-one coverage support as an extension of the HUB and assists from physician order through reimbursement, including payer prior authorization, appeals, denials, and claims resolution. The FRM educates healthcare providers on public and private payer coverage, benefit design, formulary coverage, utilization management criteria, insurance procedures, benefits investigations, and available patient funding or financial assistance programs. The FRM serves as a payer expert for the assigned geography, communicates payer changes, coordinates with the HUB and other partners, and collaborates across departments to resolve access and reimbursement issues. The position involves customer appointments in the geography two days per week, one to two home-office days per week, and remote work from home. Travel of up to 40% by automobile or plane is required. Work may involve long periods of sitting and keyboard use, along with general office demands.

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.
Experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation.
At least 2 years of experience in a 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 ability to conduct web-based meetings.
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.
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 assigned geography or within 10 miles of its border.
Must have a valid driver's license and a clean driving record.
Must be able to travel up to 40% by automobile or plane.

Nice To Haves

Bachelor's degree in business, healthcare, or a related field.
6 years of experience with specialty/biologic self-injectable products (pharmacy benefit) or physician-administered products (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 in an assigned geographic region for Patient Access and Reimbursement.
Execute the collaborative territory strategic plan in support of products.
Provide live, one-on-one coverage support as an extension of the HUB.
Assist healthcare providers from physician order through reimbursement, including prior authorization, appeals, denials, and claims resolution.
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 assigned geography and promptly communicate payer changes to stakeholders.
Educate offices about formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorization, appeals, and claims resolution.
Review patient insurance benefit options and alternate funding or financial assistance programs.
Collaborate with other departments to resolve reimbursement issues.