Key skills
CommunicationProblem SolvingPresentation SkillsAccount Management
About this role
Role Overview
- Provide on-site and on-demand education (including Lunch and Learns or Dinner presentations) for the office staff in regard to Reimbursement challenges and support services that are available.
- Office interaction will include education and reimbursement support.
- On-site/virtual interactions will average 15 per week.
- Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams.
- Monthly activity reporting captures educational topics at FRM level reportable to client based on client expectation.
- Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs.
- FRM will collaborate with case manager on average of 4/month and ad hoc as needed for escalations.
- Responsible for setting up appointments and completing outbound calls to targeted offices.
- Assist in completing backlog casework.
- Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.
- Monitor program performance for physicians and manufacturer representatives in accordance with expectations.
Requirements
- 4-year degree in related field or equivalent experience
- 4+ years of healthcare related reimbursement experience
- Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
- Experience supporting oncology products preferred
- Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
- Must have Medicare and commercial insurance coverage experience.
- Proven presentation skills and experience
- Proven ability to effectively handle multiple priorities and excellent organizational skills
- Strong Computer literacy to include PowerPoint and Web Meeting experience
- Previous field experience, a plus
- Previous experience with specialty pharmacy a plus
- Account management experience, a plus
- Excellent Interpersonal skills.
- Excellent written and oral communication skills
- Problem solving and decision-making skills
Benefits
- Competitive compensation package
- Annual bonus or long-term incentive opportunities