reimbursement manager

McKesson

<div>McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve &ndash; we care.
What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow&rsquo;s health today, we want to hear from you.
The Field Reimbursement Manager (FRM) is responsible for managing an assigned territory focused on supporting Reimbursement and Patient services by providing assistance with patient reimbursement challenges for a specific drug (including Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client-facing and customer-facing and requires the ability to build relationships with physician offices as well as manufacturer representatives to effectively deliver services based on customer specific preferences. The Field Reimbursement Manager works independently in a fast paced, highly visible environment as well as collaboratively with the internal program hub support services to ensure all customer needs are met. FRM will frequently interact via telephone with providers and internal staff to arrange site visits, Manufacturer trainings, and educational training venues. Must have a solid working knowledge of Medicare and Commercial insurance plans and benefit structures in order to relay detailed benefit information and maximize the customer experience. Position will require travel, project management and/or account coordination based on client expectation.
Key Responsibilities:<ul><li>
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. These activities are recorded in FRM CRM daily with reporting to manager weekly.</li><li>
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.</li><li>
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. These interactions are tracked in FRM CRM and hub system.</li><li>
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 FRM CRM which are reportable to management and client.</li><li>
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.</li><li>
Research and compile provider / manufacturer representative specific information for reimbursement database. (Includes account profiles) FRM will create a facility database on each new provider in FRM CRM. All interactions/activities are built utilizing this database.</li></ul>
Minimum Job Qualifications &ndash;
<ul><li>4-year degree in related field or equivalent experience</li><li>
4+ years of healthcare related reimbursement experience</li></ul> 
Business Experience &ndash;
<ul><li>Strong medical reimbursement experience with Buy &amp; Bill and/or Specialty Pharmacy.</li><li>
Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician&rsquo;s office or clinics.</li><li>
Must have Medicare and commercial insurance coverage experience.</li><li>
Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis.</li><li>
Proven presentation skills and experience</li><li>
Proven ability to effectively handle multiple priorities and excellent organizational skills</li><li>
Strong Computer literacy to include PowerPoint and Web Meeting experience
</li></ul>Specialized Knowledge/Skills &ndash;
<ul><li>Previous field experience, a plus</li><li>
Previous experience with specialty pharmacy a plus</li><li>
Account management experience, a plus</li><li>
Excellent Interpersonal skills.</li><li>
Excellent written and oral communication skills</li><li>
Problem solving and decision-making skills</li></ul>
Travel Requirements &ndash;
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
Physical Requirements (Lifting, standing, etc.) &ndash;
Possible long periods of sitting and/or keyboard work. General office demands.
We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here.
Our Base Pay Range for this position
$76,300 - $127,100
McKesson has become aware of online recruiting-related scams in which individuals who are not affiliated with or authorized by McKesson are using McKesson&rsquo;s (or affiliated entities, like CoverMyMeds or RxCrossroads) name in fraudulent emails, job postings or social media messages. In light of these scams, please bear the following in mind: 
 
McKesson Talent Advisors will never solicit money or credit card information in connection with a McKesson job application. 
McKesson Talent Advisors do not communicate with candidates via online chatrooms or using email accounts such as Gmail or Hotmail. Note that McKesson does rely on a virtual assistant (Gia) for certain recruiting-related communications with candidates.
McKesson job postings are posted on our career site: careers.mckesson.com.
McKesson is an Equal Opportunity Employer 
McKesson provides equal employment opportunities to applicants and employees, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, genetic information, or any other legally protected category. For additional information on McKesson&rsquo;s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. 
McKesson welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in all aspects of the selection process. If you require accommodation please contact us by sending an email to Disability_Accommodation@McKesson.com.
Join us at McKesson!</div>

Field Reimbursement Manager

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

UF Health Shands Hospital

<div>Overview:

Develops and executes strategies to optimize revenue while ensuring compliance with regulatory requirements. Leads negotiations with payers and government agencies to secure favorable reimbursement rates and contract terms. Oversees analysis of reimbursement trends and policies, collaborating with cross-functional teams to align initiatives with business goals. Manages reimbursement documentation, appeals, and monitors payer performance to minimize denials and delays. Advises senior leadership on reimbursement risks and opportunities is a key aspect of this position to support informed strategic decision-making.
Responsibilities:

Key Responsibilities<ul><li>Develops and executes strategies to optimize revenue.</li><li>Ensures compliance with regulatory requirements.</li><li>Leads negotiations with payers and government agencies.</li><li>Secures favorable reimbursement rates and contract terms.</li><li>Oversees analysis of reimbursement trends and policies.</li><li>Collaborates with cross-functional teams to align initiatives with business goals.</li><li>Manages reimbursement documentation, appeals, and monitors payer performance.</li><li>Advises senior leadership on reimbursement risks and opportunities.&quot;</li></ul>
Qualifications:

Qualifications<ul><li>8+ years of healthcare reimbursement leadership experience</li><li>Expertise in payer negotiations and revenue cycle management</li><li>Strong analytical and strategic planning skills</li><li>Experience managing reimbursement teams and processes</li><li>Proficient in reimbursement and billing software&quot;</li></ul></div>

Director of Reimbursement

Faculty Physicians Inc.

<div>Directs and coordinates all activities pertaining to the billing division through general or direct supervision of Reimbursement Operations. Responsible for patient services, registration quality, insurance verification, payment posting, documentation imaging, claims processing and edits; and other duties as assigned.

EDUCATION and/or EXPERIENCE
<ul>
<li>BA in related field combined with minimum five years of managed Care experience</li>
<li>Minimum three years management experience and at least two years administrative experience</li>
<li>Knowledge of back and front office operations</li>
<li>Knowledge and understanding of FPI contracts</li>
<li>Knowledge of inpatient, critical care, emergency and/or outpatient procedures</li>
<li>Current knowledge of GE/IDX, EPIC or similar computerized billing system</li>
<li>Knowledge of ICD-10 and CPT coding</li>
<li>Strong customer service skills</li>
<li>PC proficiency</li>
</ul>
Total Rewards 
The referenced base salary range represents the low and high end of University of Maryland&rsquo;s Faculty Physician&rsquo;s Inc. salary range for this position. Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications. University of Maryland Faculty Physician&rsquo;s Inc. offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://www.umfpi.org/jobs/summary-employee-benefits.</div>

Assoc. Director Reimbursement Ops- Practice Operations- Remote Opportunity

Mercalis

<div>Overview:

**SHIFTS FOR THESE ROLES ARE (4)8A-5P, (4)9A-6P, (2) 10A-7P - ALL EST; ALL M-F.** 
Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris&trade; revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.<div></div><div> 
As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient&rsquo;s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer. The primary function is to provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services. These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.</div>
Responsibilities:<div></div><div> 
<ul><li>
Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions</li><li>
Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy</li><li>
Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers</li><li>
Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient</li><li>
Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals</li><li>
Evaluate program enrollment forms for data integrity</li><li>
Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures</li><li>
Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials.</li><li>
Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities</li><li>Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)</li><li>Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers</li><li>
Maintain records in accordance with applicable standards and regulations to the programs/promotions</li><li>Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
</li><li>Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness</li><li>
Understand health and disease states of patients of the programs
</li><li>Maintains a high level of ethical conduct regarding confidentiality and privacy</li><li>
Help maintain team morale by consistently demonstrating positive attitude
</li><li>On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data</li><li>Ensure all SOPs are followed with consistency</li><li>Conducts miscellaneous tasks or projects as assigned Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) &ndash; (specific to program/client requirements)
</li></ul></div> 
Qualifications:
<ul><li>Associate or Bachelor&rsquo;s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment</li><li>
Ability to communicate effectively both orally and in writing</li><li>
Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience</li><li>
Excellent problem-solving and decision-making skills required</li><li>
Attention to detail and committed follow through in communication with patients, providers and internal stakeholders</li><li>
Strong organizational skills</li><li>
Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards</li><li>
Strong interpersonal skills, ability to work both independently and as part of a team,ability to jump in and help others as needed</li><li>
Empathetic listening skills in order to interact effectively with patients and providers</li><li>
Punctual, reliable with strong attendance record</li><li>
Proficient with Microsoft products</li></ul>
Physical Demands &amp; Work Environment<ul><li>
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.</li><li>
Although very minimal, flexibility to travel as needed is preferred.</li><li>
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.</li></ul> 
Why Work for Valeris?
We&rsquo;re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:<ul><li>
Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs</li><li>
Additional health support, including telehealth and Employee Assistance Program (EAP) services</li><li>
Company match on Health Savings Account contributions</li><li>
Free Basic Life and AD&amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000</li><li>
Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability</li><li>
401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting</li><li>
Paid Time Off (PTO) and Sick Leave to support work-life balance</li><li>
Team members receive nine paid holidays plus two floating holidays</li><li>
Opportunities for advancement in a company that supports personal and professional growth</li><li>
A challenging, stimulating work environment that encourages new ideas</li><li>
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace</li><li>
A mission-driven, inclusive culture where your work makes a meaningful impact</li></ul> 
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice. 
Our Commitment to Equal Opportunity<div>
At Valeris, we don&rsquo;t just accept difference &ndash; we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.</div></div>

Reimbursement Specialist

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