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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 deliver presentations, alongside strong organizational and problem-solving skills.
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
Claims AssistanceMedical NecessityBilling and Coding UpdatesCase ManagementSpecialty PharmacyInsurance VerificationClaim AdjudicationPatient CommunicationFRM CRMProject Management
Soft Skills
Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsDecision-Making SkillsWritten and Oral Communication Skills
Tools & Technologies
PowerPointWeb Meeting PlatformsFRM CRM
Industry Keywords
Buy & BillHealthcarePatient ServicesPhysician OfficesClaims SubmissionFacility DatabasesProvider Information
About the role
Key responsibilities & impact- Manage an assigned territory supporting reimbursement and patient services for a specific drug
- Provide assistance 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
- 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, and assistance programs
- Collaborate with case managers approximately four times per month and handle escalations as needed
- Set appointments, complete outbound calls to targeted offices, assist with backlog casework, and perform 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 and create facility databases in FRM CRM
- Travel and perform project management and/or account coordination based on client expectations
Requirements
What you’ll need- Candidate must live within the Louisville, KY 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 healthcare, including insurance verification, prior authorizations, and/or 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 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 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
- Total Rewards benefits package
- Remote, work-from-home arrangement
