Field Reimbursement Manager-Lansing/Grand Rapids
$145,471–$196,813 year
HybridLansing, Michigan, United States or Grand Rapids, Michigan, United States
Job Summary
Manage defined accounts within a specified geographic region by executing the collaborative territory strategic plan and ensuring understanding of the reimbursement process and patient support programs. Act as an extension of the HUB, providing live one-on-one coverage support from physician order to reimbursement, including prior authorization, appeals, and denials. Review patient-specific information to resolve coverage challenges and educate healthcare providers on key payer coverage changes and benefit design criteria. Coordinate access issues with relevant partners, communicate payer changes to stakeholders, and review patient insurance benefit options and financial assistance programs. This role requires three days per week in the geography for customer appointments, with remote work options for one to two days. Travel up to 60-80% via automobile or plane is required, and a valid driver's license with a clean record is mandatory.
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
- 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
- Live in the geography or less than 10 miles from the geography border
Desired 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 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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