FRM, Field Reimbursement Manager - Michigan

Field Reimbursement Manager. FRM Michigan Territory | Various Travel Locations.

Expert in Retail Pharmacy and Specialty pharmacy drug Prior Authorizations, Appeals, and working denials, with 3 years of FRM territory management experience, and experience training and educating provider office staff.

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FIELD / TRAVEL position coving a territory of several states: Michigan, Ohio

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:

• 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.

The best FRM candidates will :

1) Bring 3 years FRM territory experience (including experience working without access to PHI)

2) Truly care about the patients and work through all roadblocks and barriers to get the medications approved and paid for.

3) Have expertise in : RETAIL Pharmacy, as well as, Specialty Drug Prior authorizations through portals, benefits investigations , working appeals and denials

4) Have LOCAL PAYOR LANDSCAPE KNOWLEDGE: Medicare & Medicaid

5) Know some work arounds when PHI is not accessible

6) Have 2-4 years experience in: escalations, education, Commercial co-pay card approvals , Patient Assistance program approvals , foundation coverage, guidelines, and reimbursement. Keeping up with changes and updates to drug programs, new FDA indications, miscellaneous J-codes, and payer policy changes that impact reimbursement.

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.

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.