managed care specialist

Syneos Health Commercial Solutions

<div>Description
The Field Reimbursement Specialist (FRS) will be responsible for the management of defined accounts in a specified geographic region in the ophthalmic therapeutic area, specifically supporting our client&rsquo;s products.
The FRS will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of reimbursement process, field reimbursement services, and patient support program. The Reimbursement Specialist will also work on patient-level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI).
Field Reimbursement Specialists manage daily activities that support appropriate patient reimbursement to our client&rsquo;s products in the provider offices and work as a liaison to other patient assistance and reimbursement support services offered by our clients. Activities include, but are not limited to:<ul><li>
Act as an extension of the product providing live one-on-one coverage support.</li><li>
Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.</li><li>
Reviewing patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges.</li><li>
Reviewing patient insurance benefit options.</li><li>
Identifying alternate funding/financial assistance programs.</li><li>
Coordinating with our client&rsquo;s patient support services programs representatives.</li><li>
Educating physician office staff on the use of our client&rsquo;s patient assistance and call center support services, including web‑based provider programs.</li><li>
Provide information on relevant reimbursement topics related to our client&rsquo;s products.</li><li>
Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.</li><li>
Provide office support in accurate coding and billing for the client&rsquo;s products.</li></ul>
Minimum Qualifications &amp; Education:<ul><li>
Bachelor&rsquo;s degree required</li><li>
Minimum two years&rsquo; of access and reimbursement, managed care, and/or billing and coding support experience</li><li>
Experience working with Buy and Bill products and a thorough understanding of the entire reimbursement process from script to injection required</li><li>
Ophthalmic, retina specialists and biosimilar experience preferred</li><li>
Experience establishing relationships within a practice by working closely to help remove reimbursement barriers to specialty products for their patients</li><li>
Knowledge of Centers of Medicare &amp; Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus</li><li>
Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus</li><li>
Ability to travel and cover large multistate geography territories, 50% travel required</li><li>
Excellent presentation and project management skills</li></ul>
The annual base salary for this position ranges from $155,000 to $160,000. The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. In addition, some positions may include eligibility to earn commissions/bonus based on company and / or individual performance.
At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn&rsquo;t align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.
Why Syneos Health? Our ability to collaborate and problem-solve makes a difference in patients&rsquo; lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients&rsquo; lives around the world.
Work Here Matters Everywhere | How are you inspired to change lives?
Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)
Syneos Health has a voluntary COVID-19 vaccination policy. We strongly encourage all employees to be fully vaccinated. Additionally, certain local governments or Syneos Health customers may have vaccine requirements that apply to some of our employees. These employees are required to submit proof of vaccination to Syneos Health and maintain compliance with these requirements.
 
At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements. 
400003488</div>

Field Reimbursement Specialist

SmithRx

<div>Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:
<ul>
<li>Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.</li>
<li>Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward&mdash;always.</li>
<li>Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.</li>
</ul>
Job Summary: 

The Formulary Operations Specialist is responsible for the technical configuration, maintenance, and quality assurance of drug formularies within our adjudication systems. As a primary steward of data accuracy across multiple platforms, you will ensure information remains synchronized and reliable to support seamless functionality across the entire organization. You will leverage advanced data manipulation skills to translate clinical strategies into flawless operational execution.

What you will do:
<ul>
<li>System Configuration &amp; Coding: Execute complex formulary coding within adjudication systems, ensuring clinical intent is accurately reflected in system logic.</li>
<li>Data Management: Utilize Advanced Excel and Google Sheets (VLOOKUP, Index/Match, Pivot Tables, and complex nested formulas) to manipulate large datasets.</li>
<li>Adjudication Oversight: Apply deep knowledge of PBM hierarchies and adjudication logic to troubleshoot rejected claims and optimize system performance.</li>
<li>Project Leadership: Manage multiple high-priority projects simultaneously, shifting priorities fluidly to meet urgent client needs or business deadlines.</li>
</ul>
What you will bring to SmithRx:
<ul>
<li>Minimum of 2 years of direct experience in a PBM or Managed Care environment.</li>
<li>Having an active Pharmacy Technician license or registration is highly preferred.</li>
<li>Expert-level capability in Excel and Google Sheets, specifically for data cleaning, transformation, and complex formula building.</li>
<li>Proven experience in formulary management systems and a strong grasp of adjudication coding and hierarchy structures.</li>
<li>Deep knowledge of Medispan drug information or similar drug database platforms.</li>
<li>Analytical Thinking: Exceptional critical thinking skills and the ability to solve complex problems independently.</li>
<li>Detail Orientation: Meticulous attention to detail when managing high-stakes data updates.</li>
<li>Adaptability: The ability to thrive and remain composed in a demanding, constantly evolving landscape.</li>
<li>Project Management: Strong organizational skills with the ability to manage timelines and prioritize tasks according to business and client urgency.</li>
<li>Systems Thinking Mindset: The ability to look beyond the immediate task to understand how system updates ripple through the entire system.</li>
</ul>
What SmithRx Offers You:
<ul>
<li>Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&amp;D Insurance</li>
<li>Flexible Spending Benefits</li>
<li>401(k) Retirement Savings Program</li>
<li>Short-term and long-term disability</li>
<li>Discretionary Paid Time Off</li>
<li>Paid Company Holidays</li>
<li>Wellness Benefits</li>
<li>Commuter Benefits</li>
<li>Paid Parental Leave benefits</li>
<li>Employee Assistance Program (EAP)</li>
<li>Well-stocked kitchen in office locations</li>
<li>Professional development and training opportunities</li></ul></div>

Formulary Operations Analyst

DataAnnotation

<div>
 We are looking for a
 
 Clinical Appeals Nurse
 
 to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation &amp; HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement &amp; Patient Safety, Regulatory Compliance, Accreditation &amp; Medical Staff, Care Coordination &amp; Case Management, Population Health &amp; Value-Based Care, and Managed Care &amp; Utilization Management.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 Full-time or part-time remote position
 </li>
 <li>
 Choose which projects you want to work on
 </li>
 <li>
 Flexible schedule
 </li>
 <li>
 Projects are paid hourly starting at $50+ per hour
 </li>
 <li>
 Bonuses available for high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Provide AI chatbots with diverse and complex healthcare-related problems
 </li>
 <li>
 Evaluate AI outputs for logic, accuracy, and performance
 </li>
 <li>
 Ensure the medical accuracy and overall quality of model responses
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in-progress medical or healthcare-related degree
 
 
 </li>
 </ul>
 
 Notes:
 
 Payment is made via PayPal. We will never ask you for any money. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 
 #medicine
 
</div>

Clinical Appeals Nurse

SearchPlus HR

<div>SearchPlus HR is thrilled to partner with a distinguished Private Healthcare Group in the search for a Specialist in Brain Injury Medicine. In this crucial role, you will be entrusted with the assessment, diagnosis, and treatment of patients suffering from various forms of brain injuries. Your expertise will guide the development of personalized care plans, ensuring each patient receives the highest level of attention and support throughout their recovery journey.
As a Specialist in Brain Injury Medicine, you will work collaboratively with a multidisciplinary team of healthcare professionals, leveraging a comprehensive approach to care that includes rehabilitation, therapy, and patient education. Your contributions will be vital in improving patient outcomes and enhancing their quality of life.
Key Responsibilities:<ul>
<li>Conduct thorough assessments and diagnostic evaluations for patients with brain injuries.</li>
<li>Develop and implement individualized, evidence-based treatment plans.</li>
<li>Collaborate with a multidisciplinary healthcare team to coordinate comprehensive patient care.</li>
<li>Monitor and adjust treatment plans based on patient progress and outcomes.</li>
<li>Educate patients and their families about brain injury management and rehabilitation strategies.</li>
<li>Engage in continuous professional development and stay current with advancements in brain injury medicine.</li> 
</ul> 
 
Requirements 
<ul>
<li>MD or DO with an active, valid medical license.</li>
<li>Completion of a residency in Physical Medicine and Rehabilitation, Neurology, or a related specialty.</li>
<li>Board certification or eligibility in Brain Injury Medicine or a related subspecialty is preferred.</li>
<li>Demonstrated experience and expertise in diagnosing and managing brain injuries.</li>
<li>Strong communication and interpersonal skills for effective collaboration with patients and team members.</li>
<li>Ability to work effectively in a multidisciplinary team environment.</li>
<li>Empathetic and patient-centered approach to care.</li>
<li>Attention to detail and strong organizational skills.</li>
<li>Commitment to lifelong learning and professional development in the field.</li> 
</ul> 
 
Benefits 
Benefits are a Good Monthly Salary + Incentives + Standard family benefits like accommodation, Air ticket, Medical insurance, and Education allowance.</div>

Specialist Brain Injury Medicine - Private Healthcare Group

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Field Reimbursement Specialist

Field Reimbursement Specialist

Field Reimbursement Specialist

Formulary Operations Analyst

Clinical Appeals Nurse

Clinical Appeals Nurse

Specialist Brain Injury Medicine - Private Healthcare Group