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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient access and reimbursement processes, including knowledge of commercial payers, Medicare, and Medicaid. Proven ability to educate healthcare providers and resolve reimbursement issues while managing multiple projects effectively.
Highest-signal resume keywords
Patient Access ManagementMedical Reimbursement ExperienceLeadership ExperienceCollaboration SkillsProject Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Reimbursement Process KnowledgeInsurance VerificationClaim AdjudicationPayer Prior AuthorizationBilling and Coding ExpertisePresentation SkillsOrganizational SkillsProject ManagementMedical Insurance TerminologySpecialty Pharmacy Knowledge
Soft Skills
Strong Communication SkillsProblem-Solving AbilityCollaboration Skills
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft PowerPointWeb-Based Meeting Tools
Industry Keywords
Healthcare IndustryManaged CarePharmaceutical IndustryCMS PoliciesMedicare Part BMedicare Part DSpecialty/Biologic ProductsPatient Support ProgramsHUB ServicesGeographic Region Expertise
About the role
Key responsibilities & impact- Manage defined accounts within a specified geographic region for Patient Access and Reimbursement
- Support products by executing the collaborative territory strategic plan
- Ensure understanding of the reimbursement process, field reimbursement services, and patient support programs
- Resolve patient-level reimbursement issues using knowledge and experience with patient health information
- Act as an extension of the HUB, providing live one-on-one coverage support
- Assist from physician order through reimbursement, including payer prior authorization and appeals/denials requirements and forms
- Review patient-specific information when sites request assistance with coverage challenges
- Educate and update healthcare providers on private and public payer coverage changes affecting product access
- Coordinate access and reimbursement issues with relevant partners, including the HUB
- Explain product coverage under Commercial, Medicare, and Medicaid benefit designs
- Serve as a payer expert for the defined geography and communicate payer changes to stakeholders
- Provide office education on formulary coverage, utilization management, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution
- Educate offices using approved materials
- Review patient insurance benefit options and alternate funding or financial assistance programs
- Collaborate with departments to resolve reimbursement issues
- Support the Bone Health business unit across Arizona and Nevada
Requirements
What you’ll need- Doctorate degree OR Master’s degree and 3 years of customer service and/or leadership experience OR Bachelor’s degree and 5 years of customer service and/or leadership experience OR Associate’s degree and 10 years of customer service and/or leadership experience OR High school diploma / GED and 12 years of customer service and/or leadership experience
- Experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation of resources
- Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
- Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge
- Proven presentation and facilitation skills
- Strong written and oral communication skills
- Organizational skills and project management experience, including the ability to manage multiple projects
- Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
- Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers
- Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types
- Strong collaboration and ability to lead cross functional partner meetings
- Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region
- Live in the geography or less than 10 miles from the geography border
- Must have a valid driver's license with a clean driving record
- Preferred: Bachelor’s degree in business, healthcare, or a related field
- Preferred: 6 years' experience with specialty/biologic self-injectable or physician-administered products
- Advanced knowledge of medical insurance terminology
- Knowledge of CMS policies and processes with expertise in Medicare Part B and Part D
- Ability to manage ambiguity and problem-solve
- Ability to manage expenses within allocated budgets
Benefits
Comp & perks- A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
- A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
- Stock-based long-term incentives
- Award-winning time-off plans
- Flexible work models, including remote and hybrid work arrangements, where possible
- Career development opportunities
- Financial plans with opportunities to save towards retirement or other goals
- Work/life balance support
- Reasonable accommodation for individuals with disabilities