Field Reimbursement Manager

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Oversee a designated territory providing reimbursement and patient services for a particular medication.

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

• Train physician offices on payer landscapes and available services through remote interactions and in-person training sessions.

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

• Collaborate with internal program hub support services to address 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 and Dinner presentations.

• Provide office education and reimbursement support, averaging 15 on-site/virtual interactions weekly.

• Educate on Benefit Investigation, Prior Authorization processes, Support Center Services, Medicare and commercial coverage, along with patient communication methods.

• Offer reimbursement assistance for case management, billing and coding updates, claims submission, specialty pharmacy, medical benefit interpretation, medical necessity, claims and appeals, co-pay assistance, and patient assistance programs.

• Partner with case managers on around four cases each month and manage escalations as necessary.

• Arrange appointments and conduct outbound calls to targeted offices.

• Assist with backlog casework and other daily in-office tasks.

• Interact with physicians and manufacturer representatives to exchange patient- and provider-specific information.

• Document interactions and activities in FRM CRM and hub systems, providing regular management and client reports.

• Assess physician and manufacturer representative program performance using CRM dashboards and quarterly reports.

• Research and gather provider/manufacturer representative data, creating facility databases in FRM CRM.

⛳️ Requirements

• Must reside within the Philadelphia, PA region.

• Bachelor’s degree in a related field or equivalent experience.

• Minimum of 4 years of experience in healthcare-related reimbursement.

• Strong background in medical reimbursement, particularly with Buy & Bill and/or Specialty Pharmacy.

• Experience in the healthcare industry, including insurance verification, prior authorizations, and/or claim adjudication.

• Familiarity with Medicare and commercial insurance coverage.

• Ability to communicate and document benefit investigation results and provide regular status updates.

• Proven skills in presentation and experience.

• Capacity to manage multiple priorities effectively along with excellent organizational skills.

• Strong computer proficiency, including PowerPoint and web meeting technologies.

• Exceptional interpersonal abilities.

• Outstanding written and verbal communication skills.

• Strong problem-solving and decision-making capabilities.

• Must live in the territory—Philadelphia, PA.

• Willingness to travel 80% of the time (4 days a week) by car or plane.

• Possession of a valid driver's license with a clean driving history/MVR.

🏝️ Benefits

• Competitive compensation package.

• Potential for annual bonuses or long-term incentive opportunities.

• Equity may be part of the total rewards package.

• Flexible, remote work-from-home arrangement.