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Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare reimbursement processes, including Benefit Investigation, Prior Authorization, and Claims Assistance, while effectively educating healthcare providers and managing relationships. Proven ability to deliver presentations and support patient services in a fast-paced environment.
Highest-signal resume keywords
Healthcare Reimbursement ExperienceBenefit InvestigationPrior AuthorizationPresentation SkillsMedicare and Commercial Insurance Coverage
About the role
Key responsibilities & impact- Manage an assigned territory supporting reimbursement and patient services for a specific drug
- Assist with Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals
- Educate physician offices on payer landscapes and available services through remote interaction and on-site training
- Build relationships with physician offices and manufacturer representatives
- Collaborate with internal program hub support services to meet customer needs
- Arrange site visits, manufacturer trainings, and educational training venues by telephone
- Provide on-site and on-demand education, including Lunch and Learns or Dinner presentations
- Deliver reimbursement education and support through on-site and virtual interactions averaging 15 per week
- Record activities in the FRM CRM daily and report to the manager weekly
- Educate on Benefit Investigation, Prior Authorization, Support Center Services, Medicare and commercial coverage, and patient communication streams
- Provide reimbursement support for case management, billing and coding updates, claims submission, specialty pharmacy, medical benefit interpretation, medical necessity, claims and appeals, co-pay assistance, and patient assistance programs
- Collaborate with case managers on average four times per month and as needed for escalations
- Set appointments and complete outbound calls to targeted offices
- Assist with backlog casework and day-to-day in-office work
- Interface with physicians and manufacturer representatives to exchange patient- and provider-specific information
- Monitor program and territory performance using FRM CRM dashboards and quarterly reporting
- Research and compile provider/manufacturer representative information for reimbursement databases and create facility databases for new providers
Requirements
What you’ll need- 4-year degree in related field or equivalent experience
- 4+ years of healthcare related reimbursement experience
- Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy
- Experience in the healthcare industry, including insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics
- Medicare and commercial insurance coverage experience
- Ability to deliver and document benefit investigation outcomes and relay status reports regularly
- Proven presentation skills and experience
- Ability to effectively handle multiple priorities and excellent organizational skills
- Strong computer literacy, including PowerPoint and web meeting experience
- Excellent interpersonal skills
- Excellent written and oral communication skills
- Problem-solving and decision-making skills
- Must reside in the 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
Benefits
Comp & perks- Competitive compensation package
- Annual bonus or long-term incentive opportunities may be offered
- Remote, work-from-home arrangement
- Equal employment opportunities
- Reasonable accommodation for applicants with disabilities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical ReimbursementClaims SubmissionBilling and Coding UpdatesPatient Assistance ProgramsCase ManagementInsurance VerificationClaim AdjudicationSpecialty PharmacyDocumentation of OutcomesDatabase Research
Soft Skills
Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsDecision-Making SkillsCommunication Skills
Tools & Technologies
FRM CRMPowerPointWeb Meeting Platforms
Industry Keywords
Buy & BillPatient ServicesPayer LandscapeHealthcare IndustryProvider-Specific Information