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FIELD REIMBURSEMENT MANAGER - OHIO k

COLUMBUS, OH

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Description

Our client is a huge name in the global healthcare industry, they have been brought in to assist with a tricky Specialty Drug that is meeting a lot of challenges in Long Term Care Facilities.  

This is a territory position covering Ohio + some of the bigger cities in nearby states.   Good news - only about 30% travel , most other visits done virtually.   

Work from your home anywhere in Ohio. 

We need your expert help in Reimbursement for Specialty Drugs and expertise with Long Term Care Facilities and their Specialty Pharmacies. 

Key Responsibilities: Provide on-demand education (in-person and virtual) for the LTC facility staff in regard to Reimbursement challenges and support services that are available. Office interaction will include:

Educate:

  • Benefit Investigation / Prior Authorization Process
  • Support Center Services
  • Medicare D and commercial coverage
  • Educate on the patient communication streams

Reimbursement Support:

  • Case management
  • Billing and coding updates
  • Appropriate claims submission
  • Specialty Pharmacy
  • Medical Benefit Interpretation
  • Understanding medical necessity
  • Claims / Appeal assistance
  • Information related to co-pay assistance programs
  • Information related to patient assistance programs

Responsible for managing your territory: outbound calls to set up appointments to targeted facilities . Assist in completing backlog casework. Additional day-to-day in-office work. Interface with the Hierarchy and Leadership at the Long Term Care facilities , Physicians, and manufacturer representatives to obtain and provide patient and provider specific information. 

Research and compile provider / manufacturer representative specific information for reimbursement database.

30%/70% Travel/Virtual to facilities where they need your assistance in person to work through issues.     Arrange your own travel and appointments and virtual appointments.  

Job Requirements

Minimum Requirements

  • BA degree or at least working on it! 
  • FRM experience PLUS Long Term Care Facility experience  (how to navigate their hierarchy, how  they coordinate with physicians, and how they work with their contracted Specialty Pharmacy  
  • Medical reimbursement experience with Specialty Pharmacy.
  • Insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
  • Medicare D and commercial insurance coverage experience.
  • Deliver and document benefit investigation outcomes and relay status reports on a regular basis.
  • Ability to effectively handle multiple priorities within a changing environment.
  • Strong Computer literacy
    • Must include PowerPoint
    • Must include Web Meeting experience

Summary - the best candidate for this role will have concentrated knowledge in Specialty Pharmaceuticals and come from working with Long Term Care Facilities .   Knowledge in PA’s, copay, denials, payer knowledge, coding, J-Codes, and EOBs

Also helpful: 

  • Previous territory experience
  • Account management experience
  • Excellent Interpersonal skills verbal and written
  • Sense of customer advocacy
  • Not a sales job!
  • The territory is small enough to be very manageable. 

Interviewing immediately for EARLY JANUARY 2022 start date. 90 DAY TEMP TO HIRE ROLE  (not a project, its a true temp to hire paid weekly) 

Feel free to reach out to me, Gloria DAmbrisi directly 

Apply Now