Field Reimbursement Manager - Hartford, CT
$145,471–$196,813 year
HybridHartford, Connecticut, United States or Warwick, Rhode Island, United States
Job Summary
Manage defined accounts within Connecticut and Rhode Island for Patient Access and Reimbursement by executing the collaborative territory strategic plan. Ensure understanding of reimbursement processes, field services, and patient support programs while resolving patient-level reimbursement issues requiring knowledge of patient health information. Act as an extension of the HUB providing live one-on-one coverage support from physician order through prior authorization, appeals, and denials. Educate healthcare providers on private and public payer coverage changes, formulary criteria, and insurance procedures. Coordinate access issues with relevant partners and serve as a payer expert for the geography, communicating payer changes promptly to key stakeholders. Review patient insurance benefit options and alternate funding programs while collaborating with departments to resolve reimbursement challenges. Requires 3 days in geography and 1-2 remote days weekly; must travel 60-80% via automobile or plane with a valid driver's license.
Required Qualifications
- Doctorate degree OR Master's degree and 3 years of customer service and/or leadership experience OR Bachelor's degree and 5 years of customer service and/or leadership experience OR Associate's 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
- experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation or resources
- 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
- 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
Desired Qualifications
- Bachelor's degree in business, healthcare, or a related field
- 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 Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part B – for buy & bill products and Part D for Pharmacy products)
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