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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 service delivery and support patient needs.
Highest-signal resume keywords
Healthcare Reimbursement ExperienceBenefit InvestigationPrior AuthorizationPresentation SkillsMedicare and Commercial Insurance Coverage
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 UpdatesSpecialty PharmacyInsurance VerificationCase ManagementPatient Assistance ProgramsDocumentation of OutcomesCRM Dashboard MonitoringDatabase Creation
Soft Skills
Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsDecision-Making SkillsCommunication Skills
Tools & Technologies
PowerPointWeb MeetingFRM CRM
Industry Keywords
Buy & BillHealthcare IndustryPhysician OfficesClaims AdjudicationPatient Communication Streams
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
- Provide on-site and on-demand education, including Lunch and Learns or Dinner presentations
- Conduct approximately 15 on-site/virtual office interactions per week and document them in the FRM CRM
- 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 approximately four cases per month and handle escalations as needed
- Set up 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 physician and manufacturer representative program performance using CRM dashboards and reporting
- Research and compile provider/manufacturer representative information and create facility databases in the FRM CRM
Requirements
What you’ll need- Candidate must live within the Detroit, MI area
- 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 territory: Detroit, MI
- 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 job search or application
