Job Details

Key Responsibilities:

• Provide on-site and on-demand education (including Lunch and Learns) 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 are required based on client expectations These activities are recorded and tracked for reporting purposes daily with reporting to manager weekly.

• 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.  This trended data is also reported quarterly to client.

• 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 internal and external stakeholders required to ensure timely and efficient workflow based on program service levels agreements. All interactions and activities are tracked for reporting purposes.

• Responsible for setting up appointments and completing outbound calls to targeted offices. Assist in completing backlog casework. Additional day-to-day in-office work. Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.  All FRM interactions/activities are tracked in specified FRM CRM which are reportable to management and client.

• Monitor program performance for physicians and manufacturer representatives in accordance with expectations. Territory performance will be monitored via FRM CRM dashboard daily.  Trending results will be identified through quarterly reporting.  Additionally, clients have the option to survey customers on program performance.

Minimum Job Qualifications

Education/Training:

4-year degree in related field or equivalent experience

Business Experience:

Entry-level experience in project management

Minimum of 5 years healthcare related reimbursement experience
Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.

Experience supporting program specific drug therapy space, i.e., oncology, dermatology, etc.

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.

Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis.

Strong customer service experience

Proven presentation skills and experience

Ability to effectively handle multiple priorities within a changing environment.

Excellent organizational skills

Strong Computer literacy to include PowerPoint and Web Meeting experience.

Specialized Knowledge/Skills:

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.

Working Conditions:

General Office Demands – Remote, WFH

Travel Requirements

Must reside in territory.

Must be able to travel 80% (4 days a week) via automobile or plane.

Must have a valid driver's license with a clean driving record/ MVR.