Field Reimbursement Manager

This is a fully remote position, open to applicants in Illinois, +1 more state.

📋 Description

• Oversee a designated territory to provide support for reimbursement and patient services related to a specific medication.

• Aid in Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals processes.

• Provide education to physician offices about the payer landscape and available services through remote interactions and on-site training.

• Establish and nurture relationships with physician offices and manufacturer representatives.

• Work in partnership with internal program hub support services to fulfill customer requirements.

• Organize site visits, manufacturer training sessions, and educational training venues via telephone.

• Deliver on-site and on-demand educational sessions, including Lunch and Learns or Dinner presentations.

• Offer reimbursement education and support through both on-site and virtual interactions, averaging 15 sessions per week.

• Provide education on Benefit Investigation, the Prior Authorization Process, Support Center Services, Medicare and Commercial coverage, and patient communication channels.

• Assist with case management, billing and coding updates, claims submission, Specialty Pharmacy, Medical Benefit Interpretation, medical necessity, claims and appeal assistance, co-pay assistance, and patient assistance programs.

• Collaborate with case managers approximately 4 times per month and as needed for escalations.

• Schedule appointments and make outbound calls to targeted offices.

• Help with backlog casework and additional daily in-office tasks.

• Interface with physicians and manufacturer representatives to share patient- and provider-specific information.

• Record interactions and activities in FRM CRM and hub systems for management and client reporting purposes.

• Monitor program performance utilizing FRM CRM dashboards and quarterly reporting.

• Research and compile provider/manufacturer representative information for the reimbursement database.

• Develop a facility database for each new provider in FRM CRM.

⛳️ Requirements

• Candidates must reside within the Chicago, IL and Detroit, MI areas.

• A four-year degree in a related field or equivalent experience is required.

• At least 4 years of experience in healthcare-related reimbursement is necessary.

• Strong medical reimbursement knowledge with Buy & Bill and/or Specialty Pharmacy is essential.

• Experience in the healthcare sector, including insurance verification, prior authorizations, and/or claim adjudication, in physician’s offices or clinics.

• Must possess Medicare and commercial insurance coverage experience.

• Ability to deliver and document outcomes of benefit investigations and provide status reports regularly is required.

• Demonstrated presentation skills and experience are necessary.

• Proven capacity to manage multiple priorities effectively and possess excellent organizational skills.

• Strong computer skills, including proficiency in PowerPoint and Web Meeting applications.

• Previous field experience is advantageous.

• Previous experience with specialty pharmacy is a plus.

• Experience in account management is beneficial.

• Exceptional interpersonal skills are required.

• Excellent written and verbal communication abilities are necessary.

• Strong problem-solving and decision-making skills are essential.

• Must reside within the territory: Chicago, IL and Detroit, MI.

• Willingness to travel 80% of the time (4 days a week) via automobile or plane is required.

• A valid driver's license with a clean driving record/MVR is mandatory.

🏝️ Benefits

• Competitive compensation package.

• An annual bonus may be offered.

• Long-term incentive opportunities may be available.

• Comprehensive Total Rewards package.

• Equal employment opportunities provided.

• Reasonable accommodations for job search or application processes.