VetJobs
Overview
Field Reimbursement Manager – Phoenix, AZ What you will do
Manage defined accounts within a specified geographic region for Patient Access and Reimbursement. Execute the collaborative territory strategic plan to support products and ensure understanding of the reimbursement process, field reimbursement services, and patient support programs. Work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI). 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 requested help resolving issues or coverage challenges. Educate and update healthcare providers (HCPs) on 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 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, appeals, 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 (geography specific). General office demands – 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. Education and Qualifications
Minimum Education Required: High School/GED. 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 (Word, Excel, PowerPoint) and ability to conduct web-based meetings. Experience in the healthcare industry, including insurance verification, claim adjudication, physician offices or clinics, pharmacies, and/or pharmaceutical manufacturers. Proven experience with hubs and in-depth knowledge of 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 within 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 (buy & bill) and Part D (pharmacy products). Ability to manage ambiguity and problem-solve; ability to manage expenses within allocated budgets. Salary and Location
Phoenix, Arizona Additional details such as job code and affiliate sponsor were included in the original description but are omitted here to maintain a concise, focused posting.
#J-18808-Ljbffr
Field Reimbursement Manager – Phoenix, AZ What you will do
Manage defined accounts within a specified geographic region for Patient Access and Reimbursement. Execute the collaborative territory strategic plan to support products and ensure understanding of the reimbursement process, field reimbursement services, and patient support programs. Work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI). 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 requested help resolving issues or coverage challenges. Educate and update healthcare providers (HCPs) on 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 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, appeals, 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 (geography specific). General office demands – 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. Education and Qualifications
Minimum Education Required: High School/GED. 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 (Word, Excel, PowerPoint) and ability to conduct web-based meetings. Experience in the healthcare industry, including insurance verification, claim adjudication, physician offices or clinics, pharmacies, and/or pharmaceutical manufacturers. Proven experience with hubs and in-depth knowledge of 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 within 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 (buy & bill) and Part D (pharmacy products). Ability to manage ambiguity and problem-solve; ability to manage expenses within allocated budgets. Salary and Location
Phoenix, Arizona Additional details such as job code and affiliate sponsor were included in the original description but are omitted here to maintain a concise, focused posting.
#J-18808-Ljbffr