Field Reimbursement Manager

Quick Facts

The CoverMyMeds Field Reimbursement Manager (FRM) manages an assigned territory focused on supporting Reimbursement and Patient Services for a specific drug.

Description

The FRM provides assistance with patient reimbursement challenges, including Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals. The role includes educating physician offices on the payer landscape and available support services via remote interaction and on-site training, while building relationships with physician offices and manufacturer representatives. The FRM works independently and collaborates with internal support services, frequently interacting by telephone to arrange site visits and educational trainings; the role requires travel and project/account coordination based on client expectations.

Key Responsibilities

• Provide on-site and on-demand education (Lunch and Learns or Dinner presentations) to office staff regarding reimbursement challenges and available support services; interactions average 15 per week and are recorded in FRM CRM with weekly reporting.
• Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage, and patient communication streams; monthly activity reporting and quarterly trend reporting to client.
• Provide reimbursement support for case management, billing and coding updates, appropriate claims submission, specialty pharmacy, medical benefit interpretation, medical necessity understanding, claims and appeal assistance, and information related to co-pay and patient assistance programs; collaborate with case manager (~4/month) and track interactions in FRM CRM and hub system.
• Set up appointments and complete outbound calls to targeted offices; assist with backlog casework and additional day-to-day in-office work.
• Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information; track all interactions/activities in FRM CRM for management and client reporting.
• Monitor program performance for physicians and manufacturer representatives via FRM CRM dashboard daily; identify trends through quarterly reporting and optionally respond to customer surveys.
• Research and compile provider/manufacturer representative specific information for a reimbursement database (account profiles) and create facility database entries on each new provider in FRM CRM; use the database to support interactions/activities.

Requirements

• Live within the Grand Rapids or Flint, MI area.
• 4-year degree in related field or equivalent experience.
• 4+ years of healthcare related reimbursement experience.

Business Experience

• Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
• Experience in healthcare industry including insurance verification, prior authorizations, and/or claim adjudication.
• Medicare and commercial insurance coverage experience.
• Ability to deliver and document benefit investigation outcomes and relay status reports regularly.

Qualifications / Skills

• Proven presentation skills and experience.
• Proven ability to handle multiple priorities with excellent organizational skills.
• Strong computer literacy including PowerPoint and web meeting experience.
• Excellent interpersonal, written, and oral communication skills.
• Problem solving and decision-making skills.

Working Conditions

• General office demands: Remote, WFH.
• Travel requirements: reside in territory (Grand Rapids or Flint, MI) and travel 80% (4 days a week) via automobile or plane.
• Must have a valid driver’s license with a clean driving record (MVR).
• Possible long periods of sitting and/or keyboard work.