Field Reimbursement Manager - Phoenix, AZ

Role Summary

Field Reimbursement Manager – Phoenix, AZ

Responsibilities

• Act as an extension of the HUB, providing live one-on-one coverage support
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms
• Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges
• Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access
• Coordinate access/reimbursement issues with relevant partners, including the HUB
• Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)
• Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders
• Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution
• Educate offices using approved materials
• Review patient insurance benefit options and alternate funding/financial assistance programs
• Collaborate with other departments to resolve reimbursement issues

Working Conditions

• 3 days a week in geography for customer appointments
• General office demands ‚Äì Remote, Work from Home
• One to two home office days per week
• Must be able to travel up to 60-80% via automobile or plane
• Must have a valid driver's license with a clean driving record
• Possible long periods of sitting and/or keyboard work

What We Expect Of You

We are all different, yet we all use our unique contributions to serve patients. The field reimbursement professional we seek is a collaborator with these qualifications.

Basic Qualifications

• Doctorate degree
• OR Master‚Äôs degree and 3 years of customer service and/or leadership experience
• OR Bachelor‚Äôs degree and 5 years of customer service and/or leadership experience
• OR Associate‚Äôs degree and 10 years of customer service and/or leadership experience
• OR High school diploma / GED and 12 years of customer service and/or leadership experience
• Demonstrated experience directly managing people and/or leading teams, projects, programs, or directing the allocation of resources

Minimum Job Qualifications

• Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge
• Proven presentation and facilitation skills
• Strong written and oral communication skills
• Organizational skills and project management experience, including the ability to manage multiple projects
• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers
• Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types
• Strong collaboration and ability to lead cross functional partner meetings
• Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region
• Live in the geography or less than 10 miles from the geography border

Preferred Qualifications

• Bachelor's degree in business, healthcare, or a related field
• 6 years' experience with specialty/biologic self-injectable (pharmacy benefit) or physician-administered (buy and bill/medical benefit) products
• Advanced knowledge of medical insurance terminology
• Knowledge of CMS policies and processes with expertise in Medicare Part B and Part D
• Ability to manage ambiguity and problem-solve
• Ability to manage expenses within allocated budgets
• Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge
• Proven presentation and facilitation skills
• Strong written and oral communication skills
• Organizational skills and project management experience, including the ability to manage multiple projects
• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers