Job Description

Field Reimbursement Manager:

- 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.

Key Responsibilities

1. Act as a strategic reimbursement advisor and primary liaison for healthcare providers, proactively identifying and resolving complex access and reimbursement barriers for assigned therapies.

2. Lead the resolution of high-impact reimbursement cases by overseeing benefit investigations, prior authorizations, claims escalations, and appeals, ensuring timely patient access.

3. Design and deliver advanced payer insights tailored to provider needs, incorporating evolving policy trends and access strategies across remote and in-person platforms.

4. Cultivate and expand strategic partnerships with key provider offices and manufacturer stakeholders to align support services with evolving customer and market dynamics.

5. Drive cross-functional collaboration with internal hub operations, analytics, and client teams to optimize service delivery and elevate the provider and patient experience.

6. Plan and facilitate high-value site engagements, including manufacturer-sponsored training and regional educational forums, to enhance provider readiness and adoption.

7. Serve as a subject matter expert on Medicare and commercial payer structures, translating complex benefit data into actionable insights for stakeholders.

8. Represent the FRM function in field-based initiatives, territory planning, and stakeholder engagement strategies to maximize visibility and impact.

9. Oversee territory-level project execution and account coordination, ensuring alignment with client KPIs, compliance standards, and program milestones.

10. Operate with a high degree of autonomy in a dynamic, client-facing environment, consistently delivering results under tight timelines and shifting priorities.

11. Lead documentation and reporting of all field activities in the FRM CRM system, ensuring data integrity and visibility for internal and client stakeholders.

Minimum Job Qualifications Education/Training:

• 4-year degree in related field or equivalent experience Business Experience:

• Entry-level experience in project management

• Minimum of 8 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. Confidentiality Notice: This document, including any attachments, is for the sole use of its intended recipients and may contain confidential, Work Instructions

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

Physical Requirements:

? Possible long periods of sitting and/or keyboard work. General office demands.

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