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Core Competencies
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 patient services. Proven ability to build relationships and collaborate with internal teams to enhance customer support and program performance.
Highest-signal resume keywords
Healthcare Reimbursement ExperienceBenefit InvestigationPrior AuthorizationPresentation SkillsMedical Necessity
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 CodingInsurance VerificationGLP-1 ProductsCardiology ProductsPatient Assistance ProgramsCopay AssistanceFRM CRMDatabase Management
Soft Skills
Interpersonal CommunicationOrganizational SkillsProblem-SolvingDecision-MakingWritten Communication
Tools & Technologies
PowerPointWeb Meeting PlatformsFRM CRM Dashboards
Industry Keywords
Healthcare IndustrySpecialty PharmacyMedicare CoverageCommercial InsuranceClaims Adjudication
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 and Dinner presentations
- Conduct approximately 15 on-site or virtual office interactions per week
- Record activities in FRM CRM daily and report to management 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, copay assistance, and patient assistance programs
- Collaborate with case managers on approximately four cases per month and handle escalations as needed
- Set appointments, complete outbound calls to targeted offices, and assist with backlog casework
- Interface with physicians and manufacturer representatives to exchange patient- and provider-specific information
- Monitor program and territory performance through FRM CRM dashboards and quarterly reporting
- Research and compile provider and manufacturer representative information for the reimbursement database
- Create facility databases for new providers in FRM CRM
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 supporting GLP-1 and Cardiology products
- Healthcare industry experience, including insurance verification, prior authorizations, and/or claim adjudication
- Experience with Medicare and commercial insurance coverage
- Ability to deliver and document benefit investigation outcomes and relay regular status reports
- Proven presentation skills and experience
- Ability to handle multiple priorities with excellent organizational skills
- Computer literacy, including PowerPoint and web meeting experience
- Excellent interpersonal, written, and oral communication skills
- Problem-solving and decision-making skills
- Must reside in the assigned territory
- Must be able to travel 80% (4 days a week) by automobile or plane
- Must have a valid driver's license with a clean driving record/MVR
Benefits
Comp & perks- Competitive compensation package
- Annual bonus opportunities
- Long-term incentive opportunities
- Equity may be included in compensation
- Remote, work-from-home arrangement
- Equal employment opportunities
- Reasonable accommodation for job search or application
