Manager, Field Reimbursement

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

📋 Description

• Oversees employee job performance to guarantee that all tasks are completed according to specifications and deadlines.

• Conducts performance evaluations and offers constructive feedback to direct reports.

• Provides daily guidance to team members regarding their job responsibilities.

• Assists associates in resolving work-related challenges.

• Aids in the hiring and termination processes.

• Supports the creation of program training materials.

• Ensures effective communication with the staff.

• Proactively identifies program-related issues and suggests solutions to address concerns.

• Maintains a positive relationship with both internal and external customers.

• Understands and adheres to contract obligations.

• Analyzes reports for trends and provides recommendations.

• Interacts with key stakeholders within healthcare provider clinics, physician practices, or hospital outpatient settings.

• Acts as a liaison between healthcare provider offices and CareMetx program teams to facilitate complex reimbursement cases.

• Leads complicated or escalated reimbursement cases within the assigned territory, exploring options for both patients and providers to access prescribed therapies.

• Validates Prior Authorization and Appeal Requirements, communicating as necessary to stakeholders.

• Tracks electronic billing codes for pharmacy and medical payers.

• Develops Appeal Packages for the patient support program, ensuring communication regarding the status of Appeals, if applicable.

• Coordinates with representatives of the patient support program.

• Assists program teams in managing escalated medical and pharmacy billing issues.

• Aids in resolving reimbursement challenges.

• Provides information on relevant reimbursement topics related to our client's products.

• Educates clinics and physician offices about the patient support program and its services.

• Communicates effectively with patients, families, providers, manufacturers, and team members.

⛳️ Requirements

• Over 5 years of experience working with specialty healthcare providers in both pharmacy and medical billing (including buy and bill).

• At least 2 years of supervisory experience is mandatory.

• Technical expertise in healthcare reimbursement, including coding, billing, appeals processes, and navigating complex reimbursement issues with both patients and providers.

• An advanced degree or specific Practice Management experience is preferred.

🏝️ Benefits

• Outstanding customer service to both internal and external customers.

• Flexible work arrangements.