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Manager, Field Reimbursement
CareMetx, LLCManager of Field Reimbursement at CareMetx overseeing patient access solutions and reimbursement issues. Responsible for ensuring patient access and utilization of services under the Field Reimbursement program.
About the role
Key responsibilities & impact- Monitors employee job performance to ensure that all necessary tasks are completed in accordance with specifications and deadlines
- Conducts performance reviews and provides feedback to direct reports
- Provides day-to-day instructions to team members on job responsibilities
- Helps associates resolve work-related issues
- Assist with the hiring and termination process
- Assist with the development of program training documents
- Ensures open communication with the staff
- Proactively identifies program issues and proposes ways in which to address their concerns
- Maintains positive rapport with internal and external customers
- Understands contract obligations
- Analyzes reports for trends and gives recommendations
- 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
- Validate Prior Authorization and Appeal Requirements and communicate as needed to stakeholders
- Track electronic payer billing codes for pharmacy and medical payers
- Develops 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
Requirements
What you’ll need- 5+ years experience working with specialty healthcare providers for both pharmacy and medical billing (including buy and bill)
- Previous 2+ years supervisory experience is required
- 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- Exceptional customer service to internal and external customers
- Flexible work arrangements
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 processelectronic payer billing codesPrior AuthorizationAppeal Requirementsprogram training documentspatient support programreimbursement challenges
Soft Skills
performance reviewsfeedbackcommunicationproblem-solvingteam leadershiprapport buildingstakeholder interactioninstructionconflict resolutioneducation
Certifications
advanced degreePractice Management experience