Manager, Field Reimbursement

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CareMetx, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

Healthcare Insurance

CareMetx, LLC is a company that specializes in transforming patient access to specialty therapeutics by reducing the time to therapy. They offer a digital Hub service that addresses emotional, financial, and clinical barriers for patients, aiming to improve treatment timelines and ongoing therapy use. CareMetx provides high-touch support and utilizes advanced technology to offer solutions for access, affordability, and adherence, benefiting both patients and healthcare providers. They partner with specialty pharmaceutical brands, healthcare providers, and hospital systems to enhance patient outcomes.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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