Field Reimbursement Manager

• Manage an assigned territory supporting reimbursement and patient services for a specific drug
• Assist with Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals
• Educate physician offices on payer landscape and available services through remote interactions and on-site training
• Build relationships with physician offices and manufacturer representatives
• Collaborate with internal program hub support services to meet customer needs
• Arrange site visits, manufacturer trainings, and educational training venues
• Provide on-site and on-demand education, including Lunch and Learns or Dinner presentations
• Conduct office education and reimbursement support through on-site and virtual interactions averaging 15 per week
• Educate on Benefit Investigation, Prior Authorization, Support Center Services, Medicare and Commercial coverage, and patient communication streams
• Support 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
• Collaborate with case managers on an average of 4 cases per month and as needed for escalations
• Set up appointments and complete outbound calls to targeted offices
• Assist with backlog casework and day-to-day in-office work
• Interface with physicians and manufacturer representatives to obtain and provide patient- and provider-specific information
• Track all interactions and activities in FRM CRM and report to management and clients
• Monitor territory and program performance using the FRM CRM dashboard and quarterly reporting
• Research and compile provider/manufacturer representative information for the reimbursement database
• Create facility databases for new providers in FRM CRM

• Candidate must live within Orlando or Jacksonville, FL
• 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 the healthcare industry 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 on a regular basis
• 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
• Excellent interpersonal skills
• Excellent written and oral communication skills
• Problem solving and decision-making skills
• Must reside in the territory:
  Orlando or Jacksonville, FL
• Must be able to travel 80% (4 days a week) via automobile or plane
• Must have a valid driver's license with a clean driving record/MVR

Demonstrates expertise in healthcare reimbursement processes, including Benefit Investigation, Prior Authorization, and claims management. Proven ability to educate and build relationships with healthcare providers while effectively managing multiple priorities.

• Healthcare Reimbursement Experience
• Benefit Investigation
• Prior Authorization
• Presentation Skills
• Medicare and Commercial Insurance Coverage

• Claims Assistance
• Medical Benefit Interpretation
• Billing and Coding Updates
• Co-Pay Assistance
• Patient Assistance Programs
• Insurance Verification
• Claim Adjudication
• Specialty Pharmacy
• Buy & Bill
• Database Creation

• Excellent Interpersonal Skills
• Organizational Skills
• Problem Solving
• Decision-Making
• Written and Oral Communication Skills

• Valid Driver's License

• Healthcare Industry
• Patient Services
• Physician Offices
• Manufacturer Representatives
• Claims Submission

• FRM CRM
• Power Point
• Web Meeting