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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 managing relationships with physician offices and providing educational support. Proficient in utilizing CRM tools for monitoring performance and documenting interactions.
Highest-signal resume keywords
Healthcare Reimbursement ExperienceBenefit InvestigationPrior AuthorizationPresentation SkillsInsurance Verification
About the role
Key responsibilities & impact- Manage an assigned territory supporting reimbursement and patient services for a specific drug
- Assist physician offices with benefit investigation, prior authorization, claims assistance, and appeals
- Educate offices on payer landscapes and available services through remote interactions and on-site training
- Build relationships with physician offices and manufacturer representatives
- Provide on-site and on-demand education, including Lunch and Learns and Dinner presentations
- Deliver reimbursement support involving case management, billing and coding updates, claims submission, specialty pharmacy, medical benefit interpretation, medical necessity, appeals, and assistance programs
- 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 regarding patient- and provider-specific information
- Monitor territory and program performance through FRM CRM dashboards and quarterly reporting
- Research and compile provider and manufacturer representative information for reimbursement databases
- Create facility databases for new providers in FRM CRM
- Record interactions and activities in FRM CRM and report to management and clients
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 with insurance verification, prior authorizations, claim adjudication, physician’s offices, 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 handle multiple priorities and 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% (four 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 or long-term incentive opportunities may be offered
- Equity may be included as part of total rewards
- 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 AssistanceBilling and CodingCase ManagementSpecialty PharmacyMedical Benefit InterpretationAppealsDatabase CreationReportingInsurance Coverage Experience
Soft Skills
Interpersonal CommunicationOrganizational SkillsProblem-SolvingDecision-MakingWritten Communication
Tools & Technologies
FRM CRMPowerPointWeb Meeting Platforms
Industry Keywords
Buy & BillMedicareCommercial InsurancePhysician OfficesPatient Services