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Field Reimbursement Manager, San Diego Area

San Diego, CA

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Our client is a huge name in the global healthcare industry and adding to the team.

This is a territory Travel position, based out of your home in the San Diego area.  Covering Southern Cal with a concentration near San Diego 

Newly launched drug (already launched) will be dealing with mainly Neurologist offices.    It's a specialty drug /Benefits

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


  • Benefit Investigation / Prior Authorization Process
  • Support Center Services
  • Medicare 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 offices. Assist in completing backlog casework. Additional day-to-day in-office work. Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information. 

Monitor program performance for physicians and manufacturer representatives in accordance with expectations.

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

Travel M-Th (by car or flight).   Arrange your own travel and appointments within your territory.    Emphasis is on live in-person office visitations. Usually Mon- Thur with Fridays your at home office day  

Job Requirements

Minimum Requirements

  • This is a good role for an FRM looking for stability or someone who's next logical step in their career is FRM.   
  • BA degree 
  • 2+ years healthcare related reimbursement experience, reimbursement advocacy 
  • Medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
  • Insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
  • Medicare 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 knowledge in PA’s, copay, denials, payer knowledge, coding, J-Codes, and EOBs

  • Previous territory experience
  • Account management experience
  • Excellent Interpersonal skills verbal and written
  • Sense of customer advocacy
  • Not a sales job!

Interviewing immediately for April 2023  date. 90 DAY TEMP TO HIRE ROLE

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