RN Care Manager – Pediatrics
Centene Corporation
Field Reimbursement Manager
EVERSANA
full-time
Posted on:
Location Type: Remote
Location: Remote • New Jersey • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Proactively address patient access barriers by working with customers and accounts to resolve complex reimbursement issues, including prior authorizations, appeals, and denials.
- Educate private practices, multi-specialty groups, facilities, and their staff on reimbursement support programs, coverage, coding, and payer policies.
- Partner with internal and external stakeholders to identify, anticipate, and address patient and practice reimbursement challenges.
- Collaborate cross-functionally with Market Access, Patient Services, and Field Sales to provide compliant support for patients’ access to therapy.
- Deliver clear and actionable information to practice managers, billing staff, nurses, and reimbursement teams to improve their understanding of payer policies and processes.
- Conduct regular reviews with practices to understand their utilization of reimbursement support services and recommend program enhancements based on customer needs.
- Share insights into customer needs, potential access barriers, and payer trends with internal teams to drive actionable improvements.
Requirements
- Bachelor’s Degree
- Proven experience in resolving complex patient access challenges, including prior authorizations, appeals, and denials.
- Strong knowledge of the US healthcare system, reimbursement policies, and patient assistance programs.
- Familiarity with the appropriate handling and use of PHI under HIPAA and other relevant legal frameworks.
- Expertise in sales, sales management, marketing, training, market access, or account management
- Demonstrated ability to collaborate cross-functionally and manage stakeholder relationships effectively.
- Ability to analyze customer insights and market dynamics to adapt strategies for patient access and support.
- Willingness to travel as needed for field activities, meetings, and conferences, including overnight travel (>75%)
Benefits
- Health insurance
- Professional development opportunities
- Paid time off
- Flexible working hours
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
reimbursement policiesprior authorizationsappealsdenialspatient assistance programssales managementmarket accessaccount managementcustomer insights analysisstakeholder relationship management
Soft skills
collaborationcommunicationproblem-solvingcustomer serviceadaptabilityorganizational skillsanalytical skillsproactive approachtrainingleadership
Certifications
Bachelor’s DegreeHIPAA compliance
