Field Reimbursement Manager

🔥 0 minutes ago

🌵 Arizona, Colorado, +4 more states – Remote

🌵 Arizona – Remote ⛰️ Colorado – Remote 🌶️ New Mexico – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🦬 Wyoming – Remote

💵 $90k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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HeartFlow, Inc

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💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

HeartFlow, Inc. is a company pioneering in the field of cardiovascular diagnostics and care, utilizing advanced medical imaging and artificial intelligence. It offers a non-invasive personalized cardiac test that provides visualization of coronary arteries, allowing physicians to develop effective treatment plans for heart disease, which is the leading cause of death. HeartFlow’s technology combines human expertise and AI-powered tools to offer physicians critical insights without the need for invasive procedures, thus enhancing safety and efficiency in cardiovascular care. The company's solutions, such as the FFR CT Analysis, are widely adopted among top hospitals, delivering accurate and timely assessments of heart health.

📋 Description

• Operate as the embedded reimbursement expert within the commercial field team • Attend strategic customer calls to address complex coding, billing, and access concerns • Partner with the Field Sales Team to identify facilities needing reimbursement support and develop strategies • Educate the commercial team on coding updates, billing trends, and payer developments • Provide reimbursement support for providers and hospital billing and administrative leadership • Conduct onsite visits and remote consultations on billing scenarios, documentation requirements, and payment components • Support customers across the full reimbursement cycle, from pre-service authorization through post-service claims and appeals • Optimize prior authorization workflows and claims appeals processes • Review and optimize chargemaster setup for accurate charge capture and reimbursement • Conduct claim reviews, identify patterns, and recommend resolutions • Resolve patient coverage, access, and reimbursement questions with internal stakeholders • Identify gaps in educational resources and communicate needs internally • Monitor and communicate payer policy changes, CMS coverage determinations, and market access trends • Surface systemic reimbursement opportunities and barriers to inform organizational strategy • Maintain fluency in payer medical policies, prior authorization trends, and claims adjudication patterns across the Southwest

🎯 Requirements

• 5+ years of coding and billing experience managing both governmental and commercial claims, with demonstrated customer-facing or education/training responsibilities • Demonstrated experience in medical service coding and reimbursement, including direct support of large health system or hospital billing optimization • Proven experience operating alongside or embedded within a commercial sales organization • Must reside in TX, CO, AZ, NM, WY, or UT • Expert knowledge of medical coding (CPT, ICD-10-CM/PCS), payer policies, prior authorization workflows, and claims appeals processes across governmental and commercial payers • Proven ability to interpret CMS Local and National Coverage Determinations and commercial payer medical policies • Ability to monitor, synthesize, and act on payer policy changes, coverage trends, and access barriers • Outstanding ability to translate complex reimbursement concepts into clear, actionable guidance • Proficient in Microsoft Office Suite with advanced Excel skills • Unwavering commitment to ethical business practices and compliance • Bachelor's degree in a related field preferred; equivalent combination of education and experience will be considered • CPC, COC, or CCS certification preferred • RHIA or CHBME certification preferred • Prior medical device, diagnostics, or specialty pharma field reimbursement experience preferred • Familiarity with CMS NCD/LCD processes and commercial payer medical policy interpretation preferred • Experience with cardiac or advanced imaging reimbursement and radiology benefit manager prior authorization preferred • Working knowledge of the Southwest payer landscape preferred

🏖️ Benefits

• Bonus • Remote, field-based work • Approximately 30% travel within the territory

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