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Field Reimbursement Manager
CareMetx, LLCField Reimbursement Manager responsible for navigating reimbursement challenges and facilitating patient access in specialty healthcare. Collaborate with providers and internal teams to optimize patient support services.
About the role
Key responsibilities & impact- Interact with key stakeholders within healthcare provider clinics, physician practices, or hospital outpatient locations
- Act as a liaison between healthcare provider offices and CareMetx program teams to support complex reimbursement cases
- Take the lead on complicated or escalated reimbursement cases in assigned territory, navigating options for both patients and providers to access prescribed therapies for patients
- Validate Prior Authorization and Appeal Requirements and communicate as needed to stakeholders
- Track electronic payer billing codes for pharmacy and medical payers
- Develop Appeal Package for patient support program; ensures communication occurs between stakeholders on status of Appeal, if applicable
- Coordinates with patient support program representatives
- Assist program teams with handling escalated medical and pharmacy billing challenges
- Assist with resolving reimbursement challenges
- Provides information on relevant reimbursement topics related to our client’s products
- Educate clinics/physician’s offices on patient support program and services
- Effectively communicates with patients, family, provider, manufacturer and team members
- Provides exceptional customer service to internal and external customers resolves any customer request in a timely and accurate manner, escalates complaints accordingly
- Assist in development of standard operating procedures regarding payer creation, payer database management and prior authorization forms library
- Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate
- Independently and effectively resolves complex accounts with minimal supervision
- Handles complex issues where analysis of situations or data requires an in-depth evaluation of variable factors
- Networks with key contacts outside their own area of expertise
- Acts independently to determine methods and procedures on new or special assignments
- Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results
- Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled
- Performs related duties as assigned
Requirements
What you’ll need- 5+ years’ experience working with specialty healthcare providers for both pharmacy and medical billing
- Experience with Retinal is highly preferred
- Technical knowledge of healthcare reimbursement including coding, billing, appeals process, and navigating complex reimbursement issues with both patients and providers
- Advanced degree or specific Practice Management experience preferred
Benefits
Comp & perks- Flexibility on schedule and hours
- Travel may be required
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
healthcare reimbursementcodingbillingappeals processPrior Authorizationelectronic payer billing codesAppeal Package developmentpayer database managementstandard operating procedurescomplex accounts resolution
Soft Skills
communicationcustomer serviceproblem-solvingindependent judgmentstakeholder engagementnetworkinganalytical thinkingtime managementteam collaborationadaptability
Certifications
advanced degreePractice Management experience