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Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in oncology and hematology-oncology, with a strong understanding of reimbursement dynamics, coding, and billing processes. Proven ability to educate healthcare providers on patient support programs and establish relationships with key stakeholders in the healthcare industry.
Highest-signal resume keywords
Oncology ExperienceHematology-Oncology ExperienceMedical Benefit ReimbursementCoding And Billing RequirementsPatient Support Program Operations
About the role
Key responsibilities & impact- Educate healthcare providers on patient support programs, access and reimbursement support tools and services
- Educate on product-specific acquisition and access options, including specialty pharmacy networks, specialty distribution, and white-bagging support
- Educate on resources available to address access issues
- Provide local expertise on national and regional payer policies, payer issues, coding changes, and appropriate claims submission processes
- Collaborate with Oncology internal stakeholders for key account management
- Report payer trends for approved products to Patient Services and MHC account management teams
- Establish and maintain relationships with appropriate providers within the territory
- Remain current on managed care, reimbursement, and policy activities
- Travel 50% of the time
Requirements
What you’ll need- Oncology and/or hematology-oncology experience strongly preferred
- Experience with physician-administered therapies, buy-and-bill products, medical benefit reimbursement, specialty distribution/pharmacy, or complex access models preferred
- Demonstrated understanding of coverage, coding, billing, reimbursement, benefit verification, prior authorization, appeals, claims submission, payer policy, affordability support, and patient support program operations
- Strong understanding of coding and billing requirements at the national and regional level across all settings of care
- Comprehensive understanding of Medicare Parts A, B, C, and D and associated reimbursement dynamics
- Must satisfy all applicable HCIR credentialing requirements and be in good standing and/or eligible to obtain these credentials
- Bachelor's degree
- Valid driver's license
- 5 or more years of industry experience in access and reimbursement or account management preferred
- Extensive experience educating others on payer processes, coverage requirements, and access-related situations for specialty medicines preferred
- Strong track record of leadership within current role preferred
Benefits
Comp & perks- Paid time off (vacation, holidays, sick)
- Medical, dental, and vision insurance
- 401(k)
- Eligibility to participate in long-term incentive programs
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CoverageCodingBillingReimbursementBenefit VerificationPrior AuthorizationClaims SubmissionPayer PolicyAffordability SupportSpecialty Distribution
Soft Skills
CollaborationRelationship BuildingEducationLeadership
Certifications & Qualifications
HCIR Credentialing
Industry Keywords
Managed CarePayer PoliciesOncologyHematologySpecialty Pharmacy NetworksBuy-And-Bill ProductsAccess ModelsMedicare Parts A, B, C, DClaims Submission ProcessesPatient Support Programs