Field Reimbursement Manager

Quick Facts

• Role: CoverMyMeds Field Reimbursement Manager (FRM)

• Territory: Raleigh, NC (must reside within territory)

• Travel: Up to 80% (4 days a week) via automobile or plane

Description

The FRM manages an assigned territory focused on supporting reimbursement and patient services by addressing patient reimbursement challenges for a specific drug, including benefit investigation, prior authorization, claims assistance, and appeals. The position is client- and customer-facing, requiring relationship building with physician offices and manufacturer representatives and delivering services through remote interaction and on-site training. The FRM works independently and with internal hub support to meet customer needs, frequently interacting via telephone to arrange site visits and educational training venues, and must have strong working knowledge of Medicare and commercial benefit structures.

Responsibilities

• Provide on-site and on-demand education (Lunch and Learns or Dinner presentations) for office staff on reimbursement challenges and available support services; average ~15 interactions per week

• Record FRM activities in FRM CRM daily; provide weekly reporting to manager

• Educate on benefit investigation, prior authorization process, Support Center services, Medicare and commercial coverage, and patient communication streams

• Produce monthly activity reporting and quarterly trend reporting for educational topics based on client expectations

• 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 co-pay/patient assistance programs

• Collaborate with case manager (~4/month) and as needed for escalations; track interactions in FRM CRM and hub system

• Set up appointments and complete outbound calls to targeted offices; assist with backlog casework; additional day-to-day in-office work

• Interface with physicians and manufacturer representatives to obtain and provide patient/provider specific information; track all interactions/activities in FRM CRM

• Monitor program performance for physicians and manufacturer representatives via FRM CRM dashboard daily; use quarterly reporting for trends; optionally support client surveys

• Research and compile provider/manufacturer representative specific information for a reimbursement database (account profiles) and create facility database entries in FRM CRM for new providers

Requirements

• Candidate must live within the Raleigh, NC area

• 4-year degree in related field or equivalent experience

• 4+ years of healthcare related reimbursement experience

• Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy

• Experience in healthcare including insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics

• Must have Medicare and commercial insurance coverage experience

• Must be able to deliver and document benefit investigation outcomes and relay status reports regularly

• Proven presentation skills and experience

• Proven ability to effectively handle multiple priorities and excellent organizational skills

• Strong computer literacy including PowerPoint and Web Meeting experience

• Previous field experience (plus)

• Previous specialty pharmacy experience (plus)

• Account management experience (plus)

Benefits

• Competitive compensation package as part of Total Rewards; base pay range: $76,300 - $127,100

• May include annual bonus or long-term incentive opportunities (depending on factors such as performance, experience, skills, equity, market evaluations, and geography)

• Additional benefits included in Total Rewards (see benefits information on the posting)