Field Reimbursement Manager

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

• Function as the embedded reimbursement authority within the commercial field team.

• Participate in strategic customer discussions to tackle intricate coding, billing, and access issues.

• Collaborate with the Field Sales Team to pinpoint facilities in need of reimbursement assistance and formulate strategies.

• Inform the commercial team about updates in coding, billing trends, and payer developments.

• Offer reimbursement assistance to providers and hospital billing and administrative leadership.

• Conduct onsite visits and remote consultations regarding billing scenarios, documentation requirements, and payment components.

• Support clients throughout the entire reimbursement cycle, from pre-service authorization to post-service claims and appeals.

• Enhance prior authorization workflows and claims appeals processes.

• Assess and improve chargemaster setups for precise charge capture and reimbursement.

• Review claims, detect patterns, and suggest resolutions.

• Address patient coverage, access, and reimbursement inquiries with internal stakeholders.

• Identify deficiencies in educational resources and convey needs internally.

• Track and communicate changes in payer policies, CMS coverage determinations, and market access trends.

• Highlight systemic reimbursement opportunities and obstacles to guide organizational strategy.

• Maintain proficiency in payer medical policies, prior authorization trends, and claims adjudication patterns throughout the Southwest.

⛳️ Requirements

• Over 5 years of experience in coding and billing management for both governmental and commercial claims, with a proven record of customer-facing or education/training roles.

• Demonstrated expertise in medical service coding and reimbursement, including direct support for large health system or hospital billing optimization.

• Proven track record of working alongside or being embedded within a commercial sales organization.

• Residency in TX, CO, AZ, NM, WY, or UT is required.

• In-depth knowledge of medical coding (CPT, ICD-10-CM/PCS), payer policies, prior authorization workflows, and claims appeals processes across both governmental and commercial payers.

• Proven ability to interpret CMS Local and National Coverage Determinations and commercial payer medical policies.

• Capable of monitoring, synthesizing, and responding to payer policy changes, coverage trends, and access barriers.

• Exceptional ability to articulate complex reimbursement concepts into clear, actionable guidance.

• Proficient in Microsoft Office Suite with advanced skills in Excel.

• Strong commitment to ethical business practices and compliance.

• Bachelor's degree in a related field preferred; an equivalent combination of education and experience will also be considered.

• CPC, COC, or CCS certification is preferred.

• RHIA or CHBME certification is preferred.

• Prior experience in medical device, diagnostics, or specialty pharma field reimbursement is preferred.

• Familiarity with CMS NCD/LCD processes and interpretation of commercial payer medical policies is preferred.

• Experience with cardiac or advanced imaging reimbursement and radiology benefit manager prior authorization is preferred.

• Working knowledge of the Southwest payer landscape is preferred.

🏝️ Benefits

• Bonus.

• Remote, field-based work.

• Approximately 30% travel within the territory.