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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 physician offices on payer landscapes and available services. Proven ability to manage relationships and deliver presentations, ensuring compliance with Medicare and commercial insurance coverage requirements.
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
Claims AssistanceMedical Benefit InterpretationBilling and Coding UpdatesCopay AssistancePatient Assistance ProgramsInsurance VerificationClaim AdjudicationSpecialty PharmacyBuy & BillCRM Dashboard Monitoring
Soft Skills
Excellent Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsDecision-Making SkillsWritten and Oral Communication Skills
Tools & Technologies
FRM CRMPowerPointWeb Meeting Platforms
Industry Keywords
Healthcare Industry ExperienceMedicare CoverageCommercial Insurance CoveragePhysician Office ExperiencePatient 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 interactions 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/virtual office interactions per week and record activities 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, copay assistance, and patient assistance programs
- Set appointments, complete outbound calls to targeted offices, assist with backlog casework, and perform day-to-day office work
- Interface with physicians and manufacturer representatives to exchange patient- and provider-specific information
- Monitor program and territory performance through CRM dashboards and quarterly reporting
- Research and compile provider/manufacturer representative information and create facility databases in FRM CRM
- Travel approximately 80% by automobile or plane
Requirements
What you’ll need- 4-year degree in a related field or equivalent experience
- 4+ years of healthcare-related reimbursement experience
- Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy
- Healthcare industry experience, including insurance verification, prior authorizations, and/or claim adjudication
- Physician’s office or clinic experience
- 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 with excellent organizational skills
- 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 assigned 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
- Equity may be included as part of total rewards
- Remote, work-from-home arrangement
- Equal employment opportunities
- Reasonable accommodation for applicants with disabilities
