Manager, Field Reimbursement

🕒 Junho 9

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CareMetx, LLC

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

⚕️ Seguro de Saúde

Healthcare Insurance

CareMetx, LLC é uma empresa especializada em transformar o acesso dos pacientes a terapias especiais, reduzindo o tempo para o início do tratamento. Eles oferecem um serviço de Hub digital que aborda barreiras emocionais, financeiras e clínicas para os pacientes, visando melhorar os prazos de tratamento e o uso contínuo das terapias. A CareMetx proporciona suporte de alta qualidade e utiliza tecnologia avançada para oferecer soluções de acesso, acessibilidade e adesão, beneficiando tanto os pacientes quanto os prestadores de serviços de saúde. Eles fazem parceria com marcas farmacêuticas especializadas, prestadores de serviços de saúde e sistemas hospitalares para melhorar os resultados dos pacientes.

Descrição

• Monitors employee job performance to ensure that all necessary tasks are completed in accordance with specifications and deadlines • Conducts performance reviews and provides feedback to direct reports • Provides day-to-day instructions to team members on job responsibilities • Helps associates resolve work-related issues • Assist with the hiring and termination process • Assist with the development of program training documents • Ensures open communication with the staff • Proactively identifies program issues and proposes ways in which to address their concerns • Maintains positive rapport with internal and external customers • Understands contract obligations • Analyzes reports for trends and gives recommendations • Interact with key stakeholders within healthcare provider clinics, physician practices, or hospital outpatient locations • Act as a liaison between healthcare provider offices and CareMetx program teams to support complex reimbursement cases • Take the lead on complicated or escalated reimbursement cases in assigned territory, navigating options for both patients and providers to access prescribed therapies • Validate Prior Authorization and Appeal Requirements and communicate as needed to stakeholders • Track electronic payer billing codes for pharmacy and medical payers • Develops Appeal Package for patient support program; ensures communication occurs between stakeholders on status of Appeal, if applicable • Coordinates with patient support program representatives • Assist program teams with handling escalated medical and pharmacy billing challenges • Assist with resolving reimbursement challenges • Provides information on relevant reimbursement topics related to our client’s products • Educate clinics/physician’s offices on patient support program and services • Effectively communicates with patients, family, provider, manufacturer and team members

🎯 Requisitos

• 5+ years experience working with specialty healthcare providers for both pharmacy and medical billing (including buy and bill) • Previous 2+ years supervisory experience is required • Technical knowledge of healthcare reimbursement including coding, billing, appeals process, and navigating complex reimbursement issues with both patients and providers • Advanced degree or specific Practice Management experience preferred

🏖️ Benefícios

• Exceptional customer service to internal and external customers • Flexible work arrangements