Reimbursement Manager Resume Samples
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Reimbursement Manager Resume Samples
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HB
H Boyle
Hailie
Boyle
830 Vernice Rest
Dallas
TX
+1 (555) 849 5304
830 Vernice Rest
Dallas
TX
Phone
p
+1 (555) 849 5304
Experience
Experience
Philadelphia, PA
Reimbursement Manager
Philadelphia, PA
Leannon LLC
Philadelphia, PA
Reimbursement Manager
- Responsible for developing and implementing health economics and reimbursement strategies to support Latin America business
- In collaboration with cross-functional teams, identifies and develops strategies and tactics to enhance the value proposition of EW products, including, but not limited to the creation of health economics and outcomes research programs
- Develops and implements reimbursement (coding, coverage, payment) activities in support of existing and future products
- Understand and execute a strategy for public and private sector in Brazil
- Manages (from conception to completion) key projects for the region
- Develops economic models, dossiers, presentations and other materials to support the LA business
- Develops and implement educational programs for internal business partners, especially in Marketing and Sales on health economics and reimbursement issues
Phoenix, AZ
Field Reimbursement Manager
Phoenix, AZ
Armstrong-Bartell
Phoenix, AZ
Field Reimbursement Manager
- Help develop KOL relationships in collaboration with Territory Managers (TMs) and Regional Account Managers (RAMs) related to payer initiatives
- Establish, develop, and maintain strong working relationships with clients and client customers
- Provide leadership and marketplace insight to Managed Markets team, sales, and internal groups on key issues including managed care trends
- Assist in the development of reimbursement-related training programs for healthcare providers
- Work with practice managers to assist with the access conversion process for patients prescribed the company's products
- Work with sales personnel and managed markets account managers to identify solutions to address coverage and reimbursement barriers
- Conduct research for, and provide technical assistance pertaining to consulting engagements and call center programs
present
Houston, TX
Access & Reimbursement Manager
Houston, TX
Johns-Reilly
present
Houston, TX
Access & Reimbursement Manager
present
- Assist in managed markets training and development of the OAM’s
- Oncology Account Manager
- Develop customized solutions using corporate resources and/or outside consultants
- Senior Management
- Develop Administrative clinical and C-suite relationships
- Assist with resolving distribution access issues
- Regional Sales Manager
Education
Education
Bachelor’s Degree in Accounting
Bachelor’s Degree in Accounting
Illinois State University
Bachelor’s Degree in Accounting
Skills
Skills
- Detail oriented and highly motivated
- Knowledge and understanding of health insurance trends and developments in professional practice
- Exceptional and effective communication skills, both written and oral, for internal and external audiences at all levels; ability to develop rapport and credibility across the organization
- Strong attention to detail
- Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office
- Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position
- Strong interpersonal and communication skills and the ability to work effectively with branch departments
- Highly organized and results-oriented, with ability to multi-task and prioritize workload
- Ability to understand insurance contracts for billing purposes
- Ability to prioritize and handle multiple tasks and projects concurrently
15 Reimbursement Manager resume templates
Read our complete resume writing guides
1
Reimbursement Manager Resume Examples & Samples
- Proficient in MS Office suite - Word, Excel and PowerPoint
- Ability for some travel to serve clients
- Minimum 3 years of health care regulatory or reimbursement experience in public accounting required
- Currently located in or willing to relocate to Indianapolis, Indiana
- Bachelor’s or master’s degree in accounting required
2
Reimbursement Manager Resume Examples & Samples
- Responsible for developing and implementing health economics and reimbursement strategies to support Latin America business
- In collaboration with cross-functional teams, identifies and develops strategies and tactics to enhance the value proposition of EW products, including, but not limited to the creation of health economics and outcomes research programs
- Develops and implements reimbursement (coding, coverage, payment) activities in support of existing and future products
- Understand and execute a strategy for public and private sector in Brazil
- Manages (from conception to completion) key projects for the region
- Develops economic models, dossiers, presentations and other materials to support the LA business
- Develops and implement educational programs for internal business partners, especially in Marketing and Sales on health economics and reimbursement issues
- Identifies and analyzes economic and reimbursement issues impacting medical device utilization through pro-active collaboration with internal marketing group, including monitoring of HTAs, coverage policies and pricing
- Works across the organization and develops strong internal and external relationships to achieve reimbursement goals and objectives
- Preferred previous experience in or strong working knowledge of medical device industry, especially with functional responsibility in health economics and reimbursement planning and program implementation
- Experience working with customers (primarily hospitals and physicians), trade associations, professional and medical organizations and ability to develop mutually beneficial health economics and reimbursement strategies and tactics to support portfolio planning, commercialization, and sales/marketing objectives
- Experience working and negotiating with payer/insurance
- Bachelor Degree needed
- Excellent interpersonal and communication skills, especially presentations development required
- High level of computer skills essential with a deep understanding of spreadsheets and data analysis
- Solid understanding of key public and private payer policy infrastructure, payment methodologies coding and coverage; health policy trends, and current business challenges required
- Ability to balance strategic thinking with intricate planning and strong tactical execution required
- Exceptional project management skills required
- Travel of 25% required
- Focus of work mainly Brazil (80%), Mexico, Colombia and Chile
- In the beginning, focus on 80% private sector and 20% public sector
3
Area Reimbursement Manager Resume Examples & Samples
- Builds and maintains professional contacts with medical personnel in private practice, medical group practices and/or hospitals, and others in the patient care continuum
- Provides knowledge and education in support of the coding, coverage, reimbursement, and patient affordability for the Oncology and Immunoscience Portfolio
- Develops deep market access expertise in the assigned geography and anticipates implications for brands in the Immunoscience and Oncology Portfolio
- Approximately 25% of overnight travel required, additional requirements based territory
- This role reports to a Region Director and the entire team reports into BMS US Value, Access, & Payment
- Candidate must live in territory geography. Relocation is not available
- Candidates should have demonstrated performance in the following skills: strategic analysis, leadership, team building, direct or indirect people management, coaching, and the ability to effectively and efficiently drive performance within a matrix organization
- Minimum of 5+ years in pharmaceuticals and/or related Healthcare experience
- Account management skills and experience in the buy and bill market is preferred
- Business acumen pertaining to the adjudication of physician administered drugs in Medicare Part B and the medical benefit design of commercial payers
- Demonstrated strength in BMS Behaviors: Speed, Accountability, Passion, Innovation
- 1603383
4
Area Reimbursement Manager Resume Examples & Samples
- Approximately 20% of overnight travel required, travel requirements based on management of territory
- As this position requires operation of a Company-provided vehicle, offers of employment are contingent upon the candidate meeting the requirements of Qualified Driver, as determined by the Company in its sole discretion, including but not limited to the following
- 1603529
5
Reimbursement Manager Resume Examples & Samples
- Prepare accurate and timely cost reports for assigned facilities
- Represent the company during audits of these reports
- Develop rate-setting models based on cost report information and update those models on an as needed basis
- Continually monitor changes in regulations and methodology to ensure assigned states receive appropriate payment for services rendered
- Assist with various audits, including the annual financial audit and various government audits
6
Field Reimbursement Manager Resume Examples & Samples
- Reimbursement (coding, coverage any payment policy) expertise on manufacturer products in all places of service (POS) under both medical and pharmacy benefit designs
- Professionally represent manufacturer’s patient and physician access services
- Collaborate with manufacturer's internal teams to ensure alignment
- Provide education on the product services to support patient access to therapy
- The FRM must understand billing and claims systems for provider offices and related facilities, including all places of service (POS). This also include understanding coding, coverage and payment policies and how these elements impact patient access to appropriate medical care
- The FRM must have clinical understanding of client products sufficient to support any medical necessity position for accurate claims
- Dermatology experience required
- Coding certification a plus
- Practice management certification a plus
- Compliance certification a plus
- Coding and billing background
- Retail and specialty distribution
- Provider, retail place(s) of service experience
- Oral, injectables management
- HUB engagement experience
- Contract management
7
Regional Reimbursement Manager, Rheumatology Resume Examples & Samples
- Support implementation of reimbursement and distribution service plans to achieve product and corporate revenue and reimbursement objectives, meet customer needs, and help develop overall commercial excellence
- Execute reimbursement initiatives to increase awareness of the reimbursement system and ensure patients have access to Acthar in a timely manner
- Implement initiatives for critical payer accounts and their contracted specialty pharmacy distributors and other critical payer prospects
- Identify prospective opportunity or coverage issue
- Identify appropriate executive level(s) to contact within payer organization
- Work with sales force to identify key physicians to help implement a strategy to positively influence payer decision
- Provide additional information and follow up when necessary
- Interact with key accounts within assigned geography to assist the sales force with referral pull-through strategy. Visit these accounts on a regular basis as determined by the Sales Manager and Sales Representative
- Conduct regular field travel to interact with key accounts and address any past referral challenges and discuss any concerns regarding reimbursement
- Support RDSS department’s role as a central resource to commercial operations (sales, marketing & analytics) and corporate staff for reimbursement and distribution issues and for their ongoing development of this knowledge base in those areas
- Assist with the day-to-day management of the A.S.A.P. hub to maximize performance
- Provide case updates and coaching to their assigned sales teams to help expedite the referral process and get drug to patients as quickly as possible
- Participate in special projects and perform other duties, as required
- Minimum of 5 years’ experience working with specialty pharmaceutical products, either in field sales, practice management, or other access-related position
- Reimbursement, National Accounts management, Specialty Distribution or brand management highly desired
- Excellent communication, organizational and leadership skills also required
- Bachelor’s or higher degree required
8
Field Reimbursement Manager Resume Examples & Samples
- Reaction based activities would include case-specific issues at an account and patient level, Regional changes in access requirements and processes and education of account changes to the Specialty Sales force and Managed Markets teams
- Be able to build professional relationships while navigating sensitive conversations related to access, cost and reimbursement in a manner that supports the vision of Takeda’s partnership and commitment to the specialty community
- Proactively educate specialty sales team on key reimbursement updates as well as provide guidance on how to appropriately address account reimbursement concerns
- Excellent working knowledge of evolving reimbursement landscape and the practice management environment
9
Area Reimbursement Manager, IN Resume Examples & Samples
- Fosters team effectiveness within matrix team by sharing knowledge, experience, and information
- Provides Home Office approved reimbursement related training to District Manager and sales representatives within own geography
- Demonstrated strength in Core BMS BioPharma Behaviors: Decide and Act, Connect and Collaborate, Innovate, and Improve, and Grow and Engage
- 1604103
10
Field Reimbursement Manager Resume Examples & Samples
- The Regional Manager Field Reimbursement will be responsible for ensuring patient access to Mirena, Skyla and Essure within assigned geographical area
- Develop and implement account-specific strategies that will maximize business opportunities for growth
- This position works with medical practice decision makers, CFOs, practice administrators, pharmacy and medical directors, multi-specialty practice management groups, multi-specialty provider practices, purchasing, etc. to effectively reduce reimbursement barriers and to positively impact product uptake
- Work with sales personnel and managed markets account managers to identify solutions to address coverage and reimbursement barriers
- Develop and implement pull through plans so that the field can maximize current product position
- Depending on the issues identified, this position works closely with small regional plans to resolve access barriers to our WHC products
- Work with sales personnel and the managed markets account managers to identify areas of general customer concern in coverage and reimbursement. Develop strategies for removing barriers and effectively educating customers
- Provide leadership and marketplace insight to Managed Markets team, sales, and internal groups on key issues including managed care trends
- Depending on the issues identified, this position works closely with small regional plans to address coverage and reimbursement concerns
- Responsible for all field based reimbursement activities related to current and future WHC products
- The current territory covers Tennessee, Kentucky, Georgia and South Carolina. However, geography may be adjusted based on business needs
11
Field Reimbursement Manager Resume Examples & Samples
- Bachelor's Degree required/
- A valid driver's license issued in one (1) of the fifty (50) United States is required
- A minimum of two (2) years of industry or healthcare experience with buy and bill products is required. Billing experience highly preferred
- A proven track record of success and ability to influence and impact key stakeholders in a dynamic competitive selling environment is highly preferred
- Prior experience working with large institutions and health systems is preferred
- The ability to travel, which may include overnight / weekend travel is required
- Must live in the geography and/or be willing to relocate to the geography
12
Reimbursement Manager Resume Examples & Samples
- Bachelor's Degree required/
- A valid driver's license issued in one (1) of the fifty (50) United States is required
- A minimum of two (2) years of industry or healthcare experience with buy and bill products is required. Billing experience highly preferred
- A proven track record of success and ability to influence and impact key stakeholders in a dynamic competitive selling environment is highly preferred
- Prior experience working with large institutions and health systems is preferred
- The ability to travel, which may include overnight / weekend travel is required
- Must live in the geography and/or be willing to relocate to the geography
13
Access Reimbursement Manager Resume Examples & Samples
- Candidates should have strong interpersonal and communication skills
- Candidates should have demonstrated performance in the following skills: strategic analysis, leadership, team-building, coaching and the ability to effectively and efficiently drive performance within a matrix organization
- Bachelor’s degree or equivalent required with a minimum of 5+ years in pharmaceuticals and/or related Healthcare experience
- Demonstrated strength in BMS Behaviors: Passion, Accountability, Innovation, and Speed
14
Reimbursement Manager Resume Examples & Samples
- Revise data elements used to compute contractual adjustments based on the latest annual cost report and
- Periodic interim cost reports
- Periodically visit hospitals to assure that the hospital is complying with requirements for data collection for cost reporting and to keep updated on
- Assist in preparation of feasibility studies for new services
- Requires 5- 7 years’ relevant work experience
- Medicare and Medicaid Cost Reporting experience required
15
Reimbursement Manager Resume Examples & Samples
- Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access to the portfolio of Sun products
- Develop and maintain a relevant network of decision makers like Carrier Advisory Committee Members, State Society Officers, and key stakeholders responsible for health policy, reimbursement, and quality
- Effectively communicate key legislative and health policy updates to the field sales organization and key external stakeholders
- Provide support to local market patient foundations and physician societies for activities related to access
- Possess expertise in Medicare policies including building relationships with Medicare Administrative Contractors
- Anticipate changing payer landscape by demonstrating a deep understanding and knowledge of public payer emerging trends that can impact access for Sun’s branded products and pipeline
- Ensure processes are in place to drive clear communication with sales teams to ensure clarity of reimbursement issues and opportunities and support pull-through efforts
- Listen and respond appropriately to customer needs and questions
- Effectively and persuasively communicate with customers using effective selling, listening and negotiation skills, proper terminology and approved messaging
- Maintain thorough knowledge of Sun products
- Regularly and timely communicate with manager, as well as members of various support teams, as required
- Create and maintain a positive impression with customers
- Prepare reports for management as needed
- Participate in teleconference and live National, regional and district meetings and training sessions and represent Sun at national and/or local conventions when requested
- Operate consistent with Healthcare Compliance guidelines
16
Field Reimbursement Manager Location Resume Examples & Samples
- Reactively and appropriately respond to patient case issues at the account level and support the use of HUB services to resolve current and future problems
- Partner with Managed Markets and Sales to lead local level access strategies. Develop plans for communicating payer criteria, PA terms and updates from RAM/NAM teams to accounts, Sales and the HUB. Additionally, inform the strategy by communicating payer intelligence gained from accounts with key stakeholders (RAM/NAM, Sales, HUB)
- Conduct regular account review meetings that provide activity and trend analysis for use of HUB services and overall Takeda specialty product use
- Demonstrated willingness to collaborate and partner with internal colleagues
- Demonstrated excellence in written and verbal communication skills
- Outstanding interpersonal skills and flexibility to meet customer demands
17
Field Reimbursement Manager Resume Examples & Samples
- Respond to client requests for site visits, work with client field staff to understand account needs and site visit objectives, and work with clients and other contacts to schedule meetings as needed
- Develop content in keeping with client requests and needs. Conduct research using hotline data, team resources, and other sources, including primary or secondary sources, as needed, to develop content for presentations and prepare for presentations
- Develop and conduct product specific trainings for staff including new hires, refresher trainings, ongoing project and technical trainings. Identify program trends and opportunities for intervention with payers, and provide recommendations to client management
- Prepare and/or review client reports
- Conduct research for, and provide technical assistance pertaining to consulting engagements and call center programs
- Minimum of 3 years’ relevant experience and strong knowledge base in healthcare policy, reimbursement, market access, pharmaceutical or biotechnology sales or marketing, or similar industry
- Possesses relevant work experience to conduct site visits, audio conferences, and give presentations
18
Field Reimbursement Manager Resume Examples & Samples
- Participate in regularly scheduled team meetings and calls
- Manage travel schedule and travel arrangements effectively
- Work effectively in team environment to deliver on behalf of clients
- Prepare and submit appropriate expense reports in a timely fashion
19
Field Reimbursement Manager Resume Examples & Samples
- Develop and communicate value messaging for Stryker NV products and therapies by providing health economic and reimbursement support for customers. This may include health economic studies, health economic data analysis, reimbursement information and analysis (coverage, coding, and payment)
- Key internal customers may include new product planning teams, clinical science, operations, regulatory affairs marketing, sales, and therapy teams
- Collaborate with key customers via regional sales team target account strategies on the development, presentation and execution of U.S. HE&R economic selling tools budget impact models, reimbursement guides) to support market development and drive key target customer account revenue growth
- Assist with selling of the reimbursement consultancy program via targeted customer centric presentations
- Partner with Marketing teams throughout product life cycles to ensure our products have strong economic value propositions in an environment of increasing health economic challenges
- Identify opportunities to develop innovative tactical tools with economic analyses (i.e., cost-effectiveness, budgetary impact, etc.) for key technologies
- Includes monitoring of third-party data that may be utilized to drive the creation of these analyses
- Build relationships in key markets with physician, key hospital economic buyers and third-party payer decision makers
20
Field Reimbursement Manager, Market Access Resume Examples & Samples
- Deliver presentations to clients and client customers on site visits, via audio conferences, and by other means. Prepare for presentations, present materials, answer questions, identify issues for further follow-up, and conduct follow up as needed with accounts or clients. Participate in client meetings as appropriate
- Work on patient cases – conduct insurance verifications, pull through prior authorizations, identify and make referrals to cost sharing help, troubleshoot on insurance challenges as needed, in order to get patients started on therapy, or to help them stay on therapy
- Establish, develop, and maintain strong working relationships with clients and client customers
- Experience with research and analysis, relationship-building (with clients and/or customers), and public speaking
21
Access & Reimbursement Manager, & San Diego Resume Examples & Samples
- Coordinating case pull-through with the Patient Service Center, Case Managers, Sales, and Specialty Pharmacies
- Communicating with SPs to improve processing time and help facilitate shipment scheduling
- Excellent communication, organizational and leadership skills
22
Field Reimbursement Manager Resume Examples & Samples
- The FRM will manage daily activities that support appropriate patient access to Salix’s products across relevant sites of care to work as an extension of the patient assistance and reimbursement support services offered to providers
- Review patient benefit options, prior authorization requirements, and alternate funding/financial assistance programs
- Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles
- Coordinate with Salix’s patient support services programs representatives on patient cases and claim issues
- Educate office staff on the use of Salix’s patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to Salix’s products
- Help develop KOL relationships in collaboration with Territory Managers (TMs) and Regional Account Managers (RAMs) related to payer initiatives
- Monitor and attend Open Contractor Administrative Committee (CAC) Meetings for designated Medicare Administrative Contractors (MACs)
- Conduct policy surveillance across regional MACs to ensure appropriate coding, coverage, and payment of Salix products
- Attend and support relevant regional society meetings, coordinating support with TMs and Brand
- Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs
- Lead sales training related to product reimbursement, as appropriate
- Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets
- Understand and monitor national and regional payer trends and changes
- Work collaboratively with Managed Markets team to escalate potential payer issues
- Coordinate travel schedules to attend important access meetings with Sales Force
- Conduct pre-call planning meetings with TMs to ensure objectives and goals for each visit are established
- Minimum of two years of experience in public or private third party reimbursement; previous field reimbursement manager experience preferred
- Must have worked with a pharmaceutical, biotech, or device manufacturer sales team in a reimbursement capacity or as a contract position through a reimbursement consulting agency
- Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices under a “buy & bill” and specialty pharmacy model
- Must be able to assist prescribers and their staff with addressing barriers to appropriate patient access to Salix’s products, which requires a broad knowledge of the claims revenue cycle process
- The FRM must also possess an understanding of reimbursement considerations from a patient and provider perspective, with an ability to effectively interact and navigate within various sites of care (i.e., physician office, hospital outpatient department, ambulatory surgery center, etc.)
- Must have general payer policy knowledge including public and private payers, foundational knowledge of benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care
- All reimbursement activities are required to be conducted and managed within all appropriate legal and regulatory guidelines and require continuous monitoring of compliance with such guidelines and laws
- Public speaking / presentations / education experience required
- Ability to develop relationships with medical directors within a payer
- Demonstrated ability to conduct field-based reimbursement support and education
- Experience with reimbursement billing, coding, and appeals process
- Experience with new product launches, including billing with a miscellaneous HCPCS code, miscellaneous CPT code, and / or transition to billing with a unique HCPCS code
- Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process
- Ability to analyze and interpret regulation and legislation
- Ability to work independently, manage travel schedules, schedule visits (territory management)
- Strong computer skills (PowerPoint, Word, Excel)
- The FRM should have a travel expectation of 50-80%
- You may be required to provide hospitals proof of childhood immunizations, a negative TB test and other requirements, as set by the hospital protocol for access
23
Access & Reimbursement Manager Hematology Resume Examples & Samples
- Minimum 2 years Revenue cycle and or Reimbursement experience (Oncology preferred)
- 2 years of account management and/or managed markets experience preferred
- Industry Experience: Total 10 years
24
Field Reimbursement Manager Resume Examples & Samples
- Demonstrate deep knowledge in reimbursement and access across many Customer Support Programs and the subject matter expert in their region of the country
- Links with sales representatives, the specialty pharmacy (SP) advisory team, customer support programs, and national/regional account managers to escalate and resolve local payer issues
- Demonstrates strong problem solving skilled related to complex patient access challenges across payers and specialty pharmacies
- Peer leadership and mentoring roles
- Able to condense complex issues into simple solutions ideas by working with peers and internal stakeholder to improve the customer experience
- Educate office staff about financial assistance, alternative funding options for the uninsured and underinsured
- Educate providers on prior authorization requirements, coverage status, and payer appeals requirements, processes and timelines
- Knowledge of all phases of specialty pharmacy core services and connectivity to assist with the complexity of patient access
- Review benefits investigation results with office staff upon request once patient authorization has been obtained
- Member of internal advisory teams to provide customer insights that will lead to customer solutions
- Lead live training on customer support programs to providers for the Lilly Oncology business unit portfolio
- Knowledge of healthcare structures, payment systems, and reimbursement methodology
- Education – Bachelor’s Degree
- Valid driver's license and acceptable driving record is required
- Experience – Minimum three years of relevant work experience in the following areas
- Demonstrated ability to conduct field-based customer support and consultation related to payer coverage and payment processes
- Experience working with provider offices such as a physician practice, patient assistance programs, or similar pharmaceutical support program preferred
- Understand HIPAA rules and regulations related to patient privacy
- Excellent computer skills, including knowledge of Microsoft Office products including Outlook, Excel, Word, and Power Point
- Strong written and verbal communications as well as presentation skills
- Live within or 50 miles from the geography
25
Access & Reimbursement Manager, Pain Resume Examples & Samples
- Establish and maintain strategic relationships with assigned payer customers and provider accounts
- Maximize optimal access for the Jazz portfolio of products, enhance awareness and utilization of patient access services, and provide coding and billing education and support to key customers and accounts
- Collaborate and coordinate with regional sales team to develop reimbursement action plans for key accounts
- Monitor, document and influence coverage policy and changes that facilitate favorable reimbursement opportunities through regulatory approved communications by assigned prioritized accounts
- Collaborate with internal and external partners to maintain a reimbursement database, and communicate changes to the sales and management teams
- Leads strategy and tactical initiatives to achieve access goals at assigned key payer accounts, including Medicare Agencies (MAC Carriers) and Workers Comp Organizations, as well as collaborates with Managed Markets to target specific Commercial Payers, state Medicaid Agencies, Managed Medicaid Organizations, Healthcare Maintenance Organizations, Pharmacy Benefit Organizations, Health Care Plans, GPOs, DOD and Veterans Integrated Service Networks and other strategic healthcare entities specific to assigned reimbursement initiatives and product requirements
- Conducts annual business development reviews for Jazz corporate and division management, as well as required updates and reviews with assigned regional sales team(s)
- Provide reimbursement training and educational activities for internal and external stakeholders
- Remain current on key managed care, reimbursement, and policy activities, as well as serve as an expert for Jazz on business trends within key accounts
- Ensure all pertinent information regarding current products, new products, competitive data and overall information important to Jazz is brought to the attention of proper company personnel
- Represent Jazz at various industry functions such as reimbursement and Medicare meetings, payer policy meetings, professional organization meetings, and other meetings as assigned
- Demonstrates territory planning, priorities, and time management specific to geographical area of responsibility
- Minimum of 2-5 years of successful medical device or pharmaceutical payer reimbursement account management experience with demonstrated track record of successful achievement of objectives required
- Experience with reimbursement of injectable products in the outpatient setting preferred
- Reimbursement experience in the hospital/institutional setting
- Experience in building a team atmosphere with sales representatives required
- Ability to make sound decisions within time/resource constraints required
- Proven skills in strategic decision-making and problem-solving required
- Excellent analytical skills focusing on key accounts and uncovering business opportunities required
- Experience working with billing and medical claims personnel in healthcare settings
- Certified Coder or Billing certification preferred
- Must live near a major US airport/hub and be willing and able to travel approximately 60% of the time (3 days per week). Preferred geographic will be located in U.S. Central region
- College Graduate-Bachelor’s Degree minimum
26
Field Reimbursement Manager Resume Examples & Samples
- Demonstrate leadership among peers by consistent application and modeling of appropriate compliance, behavior and conduct
- Work with manager, peers and partners in Marketing, Sales and various Managed Markets and Trade groups to review/understand relevant franchise and managed care business plans, tactics, goals and objectives
- Spend considerable time and effort working with customer accounts and field partners in Sales reviewing and maintaining their territory business plans and progress, helping to identify reimbursement-specific opportunities or issues, as well as educating partners on the payer landscape
- Maintain a high level of Managed Care and related Managed Markets benefit structures, reimbursement mechanisms, legal and regulatory influences, and health management programs
- Maintain consistent ability to access and influence key business decision makers
- Maintain an outstanding level of Multiple Therapeutic Area knowledge, utilization management techniques, treatment, reimbursement guidelines and industry awareness
- Develop and justify budgeting requests for specific customer programs
- In a timely and accurate manner, submit all budgetary information, expenses reports, and required administrative reports to Field Leadership
- Seek out and maintain an effective level of communication with account stakeholders and decision makers
27
Field Reimbursement Manager Resume Examples & Samples
- Four years of Biotech or Pharmaceutical Sales experience
- Two to four years of Access Services and/or Managed Markets experience
- Two to four years of experience in the Oncology therapeutic area
- Experience with buy& bill physician administer specialty products
- Does not compromise ethics or integrity, or undertake legal risks while pursuing business goals
- Demonstrates leadership among peers by consistent application & modeling of appropriate compliance, behavior & conduct
- Field Based Reimbursement and/or access services related Experience
- Experience with physician administered injectable, Oncology therapeutic area preferred
- Excellent reimbursement expertise and payer knowledge preferred
- Knowledge and experience of legal and regulatory requirements related to the Biotech / Pharmaceutical industries
- Experience w large territory Development, Planning, & Support preferred
- Spends majority of time visiting customer accounts in the field ( Minimum 50-75% overnight travel)
- Works with manager, peers and partners in Marketing, Sales and various Managed Markets and Trade groups to review/understand relevant franchise and managed care business plans, tactics, goals and objectives
- Spends considerable time and effort working with field partners helping to identify reimbursement-specific opportunities or issues, as well as educating partners on the payer landscape
- Maintain an outstanding level of Multiple Therapeutic Area knowledge, utilization management techniques, and treatment and reimbursement guidelines
- Maintain a comprehensive and detailed Territory Plan
28
Field Reimbursement Manager Resume Examples & Samples
- Cross-functional collaboration with key internal (marketing and sales teams, managed care and distribution, commercial leadership team) and external (HCPs, access services providers, societies, and other professional groups) stakeholders to address access barriers to Makena
- Provide reimbursement support as needed at advisory boards or professional conferences
- Support access at the provider level for Makena by providing timely and appropriate information related to coverage, coding, and payment policies across all payers relevant to a provider’s payer landscape. This includes
- Private physician practices
- Hospitals & academic institutions
- Thought leaders and advocates
- Regional and state society advocates
- Achieve defined objectives related to customer support, issue resolution, and overall access to Makena
- Support strategic analysis and planning related to changes in local payer coverage policies
- Advise regional account managers of specific payer access challenges, or other access related payer trends
- Assist in the development of reimbursement-related training programs for healthcare providers
- Understand and be able to translate access trends and policies to assist AMAG’s efforts to address non-clinical barriers to Makena therapy
- Minimum of 5-10 years’ experience working in pharmaceutical/biotech industry
- Experience managing various market segments including product distribution and acquisition, reimbursement and coverage, patient access and financial assistance, health plans and the exchange marketplace, and physician networks
- Expert problem solving skills in a cross-functional environment
- Demonstrated ability to cultivate business to business relationships
- Demonstrated ability to work in a fast-paced, entrepreneurial environment
29
Reimbursement Manager Resume Examples & Samples
- Serves on Edit Administration Committee to approve and advise edit requests for university
- Maintains coding edits for Health System Professional Billing to ensure accuracy and compliance
- Directs and manages daily operation of departmental in-patient abstracting if completed within the Professional Billing Operations
- Analyzes Health System monthly governmental denial reports; reviews for proper coding, unbundling, concurrent care, modifiers, and compliance to ensure maximum reimbursement
- Coordinates dissemination of regulation and other contract changes with AVP of Health System Revenue Cycle and Director of Reimbursement for Health System
- Facilitate the handling of all payer audits, such as CERT, RAC, OIG, MAC, Medicaid, etc., Maintain and distribute audit activity reports accordingly. Independently working with outside regulatory parties
- Develops, implements, and evaluated policies and processes related to reimbursement methodologies
- Assure the correct identification, system loading, and communication of reimbursement methodologies for all government payors into EPIC and all other support systems. Must develop and maintain knowledge of system inputs and requirements
- Models proposed and approved changes in reimbursement methodologies to determine financial impact. This requires independent research and command of where to obtain the correct information
- Extracting large data sets to pull key information for use by other team members. Supporting business planning and decision support of senior leadership
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Field Reimbursement Manager Resume Examples & Samples
- Associates degree from an accredited university or college required, Bachelor's in healthcare preferred
- A minimum of 4 years healthcare related reimbursement experience
- A minimum of 5 years plus management experience is preferred when candidate has two-year nursing, Associate or no health related college degree
- Claims/billing or practice management experience preferred
- Coding certification a plus when other requirements are fulfilled
- Experience in the healthcare industry including, but not limited to pharmaceutical sales, insurance verification and/or claim adjudication (in physician’s office, surgical center or pharmacy and/or pharmaceutical manufacturers)
- Project management, contracting management or account management experience a plus
- Must be able to lead and coordinate multiple assets and associated teams for synergistic results
- Ability for daily travel a minimum of 4 days/wk. Overnight travel minimum 1 night per week. Flight and car travel required
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Reimbursement Manager Resume Examples & Samples
- Develops and maintains market intelligence on public and private payer markets and becomes the subject matter expert for McKesson Specialty
- Analyze the internal reimbursement business/processes and optimize the practices
- Develop and coordinate training for the contact center team
- Be the escalation point in the business for complex reimbursement
- Develop relationships with payer organizations to review and discuss complex/difficult coverage cases etc
- Monitors program reimbursement KPIs and develops reporting for Senior Management
- Monitors payer landscape and analyzes potential impacts or emerging trends
- Contribute to RFP’s on reimbursement requirements working with a cross-functional team to coordinate activities and achieve departmental goals
- Participate as needed with RFP presentations and/or attend industry events
- Interacts with various departments, as needed, to support ongoing reimbursement activities and quality improvement efforts
- Builds and maintains relationships at multiple levels across both McKesson and external reimbursement stakeholders to achieve and drive program success metrics
- Interfaces with physicians, advocates, patients, and manufacturers to obtain and to provide drug specific coverage information
- Utilizes internal resources to proactively address areas of opportunity related to the overall customer experience
- Simplifies difficult situations and issues to create executable actions to support CPS and Patient Access
- Adheres to all McKesson policies and procedures as well as federal and regional regulations regarding privacy and health information protection
- Other duties as assigned by Senior Manager
- Bachelor’s Degree required; degree in Business or Healthcare related field preferred or a minimum of 8 years healthcare related reimbursement experience and market access
- 2+ years of experience in project management
- Knowledge of clinical trials, health economics & outcomes research and regulatory affairs as these relate to formulary and reimbursement decisions
- Experience in Account/Client Management, preferably in the healthcare or pharmaceutical industry
- Leadership experience in business strategy
- Bilingualism (English/French) an asset
- Knowledge and understanding of health insurance trends and developments in professional practice
- Exceptional and effective communication skills, both written and oral, for internal and external audiences at all levels; ability to develop rapport and credibility across the organization
- Highly organized and results-oriented, with ability to multi-task and prioritize workload
- Comfortable working independently and within a team
- Strong computer skills using various office tools
- Capacity to coach, educate and mentor others
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Reimbursement Manager Resume Examples & Samples
- Promotes an environment which encourages accomplishment of company and staff objectives
- Monitors billing/collections staff efficiency through audit processes
- Coordinates with center-level management with development and training of new and existing Reimbursement personnel
- Maintains updated knowledge of industry, regulatory and reimbursement issues
- Initiates and maintains electronic billing
- Ensures Company pricing and discount policies are administered correctly
- Reviews new contracts, incorporates into system and educates staff
- Monitors large accounts and intervenes as appropriate to ensure timely reimbursement
- Researches and resolves problem accounts to ensure collection standards and decrease days sales outstanding (DSO)
- Approves adjustments as per Company policy
- Assists with month-end closing as scheduled to assure timeliness
- Attends required in-services each year
- Ensures employee attendance to all required training sessions and inservices
- Works collaboratively with other departments, including operations and managed care, to improve reimbursement process and results
- Directs, coordinates, and evaluates reimbursement staff and carries out supervisory responsibilities in accordance with the Company’s policies and applicable laws. Responsibilities may include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; succession planning; rewarding and disciplining employees; addressing complaints and resolving problems
- Complies with Human Resources policies for department. May delegate policy components, but retains responsibility for performance
- Each employee is responsible for adhering to those performance programs, policies, procedures, guidelines and internal control standards established to guide the operation of the Company. Each employee must be made aware of and understand proper internal control procedures associated with their specific job function as communicated by his/her manager
- Each employee is responsible for reporting concerns that he or she may have with respect to deficiencies in internal control
- Managers and supervisors are responsible for ensuring that internal controls are established and functioning to achieve the mission and objectives of their unit. Each employee within an area under the manager or supervisor’s direction must be made aware of and understand proper internal control procedures associated with their specific job function
- Managers and supervisors must acknowledge that utilization of internal controls is an inherent part of a manager’s responsibility, not a new or additional function, and assure that internal controls are supportive of and consistent with the operating mandate and philosophy of the Company
- Management responsibility for all Reimbursement staff; may direct subordinate supervisors
- Knowledge of HCPCS coding
- Knowledge of ICD 9 coding
- Knowledge of NDC coding
- Knowledge of electronic billing
- Knowledge of Zirmed
- Knowledge of CPR+
- Excellent calculation/math skills
- Ability to understand insurance contracts for billing purposes
- Ability to prioritize and handle multiple tasks and projects concurrently
- Strong interpersonal and communication skills and the ability to work effectively with branch departments
- Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position
- Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office
- The ability to work with confidential material and maintain confidentiality is required along with sensitivity to employees and customers needs and data
- Proficient analytical skills
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Access & Reimbursement Manager, Sleep Resume Examples & Samples
- Collaborate and coordinate with area and regional sales teams to develop payer and reimbursement action plans for key provider accounts
- Monitor, document, and communicate coverage policy and changes
- Collaborate with internal and external partners to maintain a payer coverage and reimbursement database, and communicate changes to field sales and sales management teams
- Collaborates with Managed Markets to pull-through business opportunities with Commercial Payers, state Medicaid Agencies, Managed Medicaid Organizations, Healthcare Maintenance Organizations, Pharmacy Benefit Organizations, Health Care Plans, GPOs, DOD and Veterans Integrated Service Networks and other strategic healthcare entities specific to assigned initiatives and product requirements
- Conducts annual business development reviews for Jazz corporate and division management, as well as required updates and reviews with assigned area and regional sales team(s)
- Provide managed care and reimbursement training and educational activities for internal and external stakeholders
- Remain current on key managed care, reimbursement, and policy activities, as well as serve as an expert for Jazz on business trends within key provider accounts
- Represent Jazz at various industry functions such as payer and reimbursement meetings, payer policy meetings, professional organization meetings, and other meetings as assigned
- Maintains accurate expenses within budget, timely and accurate completion of all reports, correspondence, and records as required by Jazz
- Execution of all activities within the defined Jazz regulatory and compliance program
- Maintain company manuals, reports, computer systems, records, brochures, computers and other equipment assigned to the position
- BA/BS Degree (MBA preferred), and at least 5 years of pharma, biopharmaceutical, and/or medical device experience calling on field based customers with demonstrated successful track record
- Account Management and/or Reimbursement experience working in the provider office setting, building strong customer relationships
- Experience working with HUB, Patient Services, and/or REMS programs
- Experience in building a team atmosphere with sales representatives, either with direct or indirect leadership authority
- Ability to make sound decisions within time/resource constraints
- Proven skills in strategic decision-making and problem-solving
- Excellent analytical skills focusing on key accounts and uncovering business opportunities
- Experience working with billing and medical claims personnel in healthcare settings preferred
- Proficient with MS Office including Excel, Word, PowerPoint preferred
- Candidates should live near a major airport and be willing and able to travel approximately 70-75% of the time (average 3-4 days per week)
- BA/BS Degree (MBA preferred)
- CPC, or similar coding certification preferred, not required
34
Reimbursement Manager Resume Examples & Samples
- Prepare the Medicare and Medicaid cost reports
- Work to maximize allowable reimbursement through preparing appeals and exception requests
- Work in conjunction with senior leadership on any reimbursement issues
- Maintain and reconcile Medicare reporting system
- Assist state auditors with information requests
- Full job description available after initial screening
- Bachelors’ degree in accounting, finance or related field
- 5+ years’ experience with reimbursement
- 3+ years’ experience in a healthcare leadership role preferred
35
Territory Reimbursement Manager Resume Examples & Samples
- This position will be supporting customers in Ohio (Kentucky, Indiana) territory
- Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy
- Experience in the healthcare industry including, but not limited to insurance verification and/or claim adjudication, physician’s office or clinics
- Must have Medicare and commercial insurance coverage experience
- Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis
- Account management and project management experience, a plus
36
Field Reimbursement Manager, East Resume Examples & Samples
- Increase the awareness of the Makena Care Connection patient support hub
- Serve as the internal cross-functional access expert by providing competitive intelligence and identifying barriers to Makena access
- Previous experience working with provider offices in sales, reimbursement, support services or a related role
- Deep knowledge and understanding of both commercial and government payers (state and federal) and benefit design
- Demonstrated ability to lead without authority with internal and external stakeholders
- Demonstrated proven work ethic and relationship management skills, as well as ability to manage multiple tasks concurrently
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Div Inst Reimbursement Manager Resume Examples & Samples
- Supervises Institute business office personnel
- Completes selection, placement and performance evaluations
- Develops work standards and quality assurance measurements for each position in order to meet established goals
- Develops, maintains, and improves charge capture systems, ensuring timeliness and accuracy of charge capture
- Assures the consistency and accuracy of Institute's charge master files
- Develops or updates policies and procedures for billing and reimbursement activities
- Summarizes data, monitors trends, analyzes results, and solves problems pertaining to billing and reimbursement activities
- Interprets and implements policies and procedures as mandated by governmental agencies in conjunction with Corporate Compliance and Clinical Affairs
- Oversees monitoring process and works with Clinical Affairs to provide feedback and education to providers
- Develops, maintains, and reports on all aspects of billing compliance within the Institute
- Presents reports to relevant committees
- With physician leadership, manages Institute billing compliance committee
- Develops and conducts Institute-specific education and training for new providers and business office personnel
- Assesses job-specific competencies. Leads ongoing Institute-specific education and training efforts
- A minimum three years of experience with CPT/ICD professional coding, medical billing and reimbursement, including at least 1 year of Manager/Lead experience
- A minimum of an additional 5 years of Manager/Lead experience may offset the
38
Reimbursement Manager Resume Examples & Samples
- BBA or BS in Accounting, Finance or Business
- 3+ years of reimbursement experience
- Demonstrated ability to quickly learn and utilize various financial systems
- Desire to automate processes using software
- Prepares annual Medicare, Medicaid and other third-party cost reports in compliance with rules and regulations of the respective third-party program
- Defends filed cost report, as appropriate, during the annual cost report audit
- Protects appeal rights for cost report audit adjustment(s) by ensuring compliance with required administrative appeal procedures and provides support during the appeal process
- Provides support to assigned hospitals for calculation of monthly contractual adjustments. Reviews such calculations for accuracy and propriety
- Monitors interim Medicare payments to assigned hospitals to ensure that such payments reflect estimated cost-based reimbursement for the respective accounting period
- Monitors local hospital compliance with Ardent's standard third-party accounting system
- Maintains appropriate level of expertise in the area of Medicare and Medicaid reimbursement
- Monitors regulatory changes in such programs and assists in maintaining Ardent's compliance with such program rules and regulations
- Works with external auditors in their conduct of interim and annual financial audit activities
- Supports hospital acquisition activities by actively participating in the due diligence process via evaluation of third-party reimbursement issues related to the acquisition candidate
- Assists in preparing annual hospital operations budget for contractual adjustments
- Provides decision support to operations management to evaluate hospital operations to achieve optimum financial results
- Develops and maintains good working relationships with Intermediaries / governmental agencies
- Develops and maintains good working relationships with Ardent Corporate, Group, and local hospital personnel
- Assists in review of work performed by Ardent's Reimbursement staff
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Senior Reimbursement Manager Resume Examples & Samples
- Manage program(s) per the scope of work, program and standard operating procedures within the contracted budget in one or more sites. Manage day-to-day activity of the program operation, including supervision of staff. Monitor program statistics and metrics. Resolve complex cases
- Day to day contact with complex clients for issue resolution. Lead the analysis and writing of client reports and other deliverables. Presentation of program information to internal and external customers
- Works with Manager(s) and Assoc Manager(s) to analyze operations and efficiency of the program(s). Acts as a liaison for other operational departments to research and resolve client issues. Acts as a mentor to other Managers
- Contributes to strategic and business planning for the program(s) by participating in planning activities company-wide, identifying project initiatives and operational issues, coordinating research and developing recommendations based on that research. Assists with development and tracking of budget
- Participate in interviewing prospective employees, evaluating current employees, and train employees as needed. Work to develop employee’s supervisory skills and provide direction to supervisory staff concerning performance management issues and corrective disciplinary actions
- Cultivate and manage relationships with key contacts in professional organizations and medical professional societies. Travel to and attend related meetings/conferences as required
- Bachelor’s degree in relevant discipline or equivalent work experience
- 8 - 12 years relevant experience or 6 - 10 years of experience with Master’s degree
- Pharmacy Technician License may be required depending on program and state requirements
- Excellent PC skills including Microsoft Office and Internet experience; Excellent verbal and written communication and presentation skills; Strong analytical and problem solving skills
- Knowledge and Abilities: Strong focus on book of business client satisfaction and client retention results; Ability to work cross-functionally to proactively communicate and to resolve issues with the highest sense of urgency. Highly developed written communication and documentation skills to develop project educational materials, program specific procedures, product tools, and other services – related to collateral. Networking and client interfacing skills to cultivate and manage relationships. Strong analytical skills. Ability to analyze information and target trends. Organize people and systems to achieve goals
- LI-TG1
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Reimbursement Manager Resume Examples & Samples
- Managing a team of 5-10 staff
- Liaising and communicating with schools, networks, and District leadership, as necessary, to develop open, positive and direct relationship representing the following areas
- Ability to communicate and collaborate cross functionally in an organization
- Experience with financial transactions, including employee expense reimbursements and payment processing systems
- Experience documenting transactional processing or system changes
- Experience leading teams and managing employee performance
- Previous experience managing work flows and service levels
- Experience in a customer service culture
- User training experience including new users as well as refresher trainings
- Bachelor’s degree in Finance, Accounting, or a related field is preferred but not mandatory
- Accounting and or Finance certifications such as CPA, CIA, PMP, or CFE are preferred but not mandatory
- Master’s preferred
- 3-5 years of management experience; including managing at least 4 people; overall experience of 5 years
- Detail oriented and highly motivated
- Proficient skills in Microsoft Office Suite is required
- Experience with Oracle, People Soft, Kronos, and/or other ERP and accounting systems is preferred
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Access Reimbursement Manager, Baltimore Resume Examples & Samples
- Builds and maintains professional contacts with office staff in private practice, medical group practices and/or hospitals, and others in the patient care continuum
- Develops deep market access expertise in the assigned geography and anticipates implications for brands (and their key competitors) in the Immunoscience and Oncology Portfolios
- Complies with all laws, regulations and policies that govern the conduct of BMS
- Approximately 15-20% of overnight travel required, additional requirements based territory
- This role reports to a Regional Director and the entire team reports into US Market Access Strategy
- Prefer candidate to live in territory geography. Relocation is not available
- Candidates should have demonstrated performance in the following skills: strategic analysis, leadership, team building, coaching and the ability to effectively and efficiently drive performance within a matrix organization
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Access & Reimbursement Manager, Sleep Resume Examples & Samples
- The ARM will implement strategies that achieve Business Unit and Corporate goals and objectives
- Establish and maintain strategic relationships with assigned providers and provider accounts
- Educate and enhance awareness and utilization of patient access services, ensure providers understand payer prior authorization requirements and information, and educate offices on coding and billing
- Serve as a field-based expert on the REMS program processes and procedures, including enrollment requirements for providers and patients
- Educate and inform provider offices on available patient services, collaborating and communicating with the Patient Access group and the Specialty Pharmacy to ensure optimal customer experience
43
Regional Reimbursement Manager Resume Examples & Samples
- At least 3 years of field biologics experience, ideally with injectable drugs, and a track record of success
- Minimum of 2 years’ experience in: practice management or practice billing and revenue cycle; experience with public or private third party reimbursement related to product access impact on providers; or experience in pharmaceutical or managed care industry reimbursement including provider site reimbursement interactions
- Advanced degree or specific Practice Management experience preferred
- Direct biologic launch experience highly desirable
- Ophthalmology experience
- 2-3+ years of reimbursement and account management experience
44
Access & Reimbursement Manager, Phoenix Resume Examples & Samples
- Strong understanding of insurance and benefit design with both commercial and government payers
- Background in Access & Reimbursement, Payer account management, Specialty Pharmacy distribution, Patient Services, Case Management
- Customer interaction and field travel up to 60% - overnights dependent on geography
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Reimbursement Manager Resume Examples & Samples
- Management of the US Reimbursement Team
- Develop and maintain an in depth understanding of the US reimbursement systems and healthcare policy issues
- Contribute to strategy development for reimbursement and market access
- Serve as the team’s primary point of contact with strategic business units and customers
- Oversee reimbursement applications
- Oversee reimbursement-related customer support
- Oversee reimbursement training of relevant staff
- Oversee reimbursement assessment of new technologies
- Work with all relevant stakeholders in the healthcare sector and be an active member in trade associations and other important groups
- Bachelor's degree, or experience of such kind and amount as to provide comparable background
- Minimum 2 years experience in medical device reimbursement
- 2 years experience in a team leadership, supervisory or management role
- Understanding of the US healthcare system
- Experience in working with different kinds of stakeholders within healthcare
- Demonstrated ability to provide consistent leadership in a team setting
- Demonstrated ability to manage conflict, communication & resources across multiple projects
- Proficient in Microsoft Office software (Word, Outlook, etc.)
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Immunology Field Reimbursement Manager Resume Examples & Samples
- Works with internal partners to review franchise, managed care, and divisional field sales business plans and objectives
- Acts as a subject matter expert on the payer landscape relevant to the assigned Genentech therapeutic area(s)/product(s)
- Acts as a conduit between the Field and Home Office Genentech functions for all public and private payer policies and practices that impact patient access to Genentech products
- Assists Coverage & Reimbursement with individual case management needs
- Develops ethical and customer-oriented reimbursement tactics
- Trouble-shoots field account reimbursement issues, needs, concerns, or challenges
- Spends majority of time visiting customer accounts in the field
- Proactively communicates and explains Genentech-specific reimbursement programs, policies, procedures and resources
- Works with relevant state, institutional or other societies
- Complies with all laws, regulations and policies that govern the conduct of Genentech activities
- Business travel, by air or car, is regularly required
- Strategic agility – Links responsibilities with the mission of the organization; focuses on activities that add the most value
- Communication – Listens well; expresses ideas fluently and logically; is open to input and can be depended on for truthfulness
- Teamwork and collaboration – Creates an atmosphere of openness and trust; collaborates; offers support and encouragement
- Technical and business expertise – Applies emerging knowledge and trends; builds strong relationships; contributes to expertise within and beyond assigned area
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Field Reimbursement Manager Resume Examples & Samples
- Demonstrates leadership among peers by consistent application and modelling of appropriate compliance, behavior and conduct
- Experience with physician administered injectable, Infectious Disease & Respiratory therapeutic area preferred
- Excellent reimbursement expertise and payer knowledge
- Experience with large territory Development, Planning and Support
- Spends majority of time visiting customer accounts in the field (Minimum 50-75% overnight travel)
- Spends considerable time and effort working with field partners helping to identify reimbursement-specific opportunities or issues, as well as, educating partners on the payer landscape
- Maintain a high level of Managed Care and related Managed Markets benefit structures, reimbursement mechanisms, legal and regulatory influences and health management programs
- Bachelor’s Degree required (MBA or other related graduate-level degree is preferred)
- Minimum of 5 years of total business experience in the healthcare or pharmaceutical/biotech industry
- Minimum of 4 or more years' sales, managed care or reimbursement experience
- Infectious Disease, Respiratory, Inflammation, Autoimmune, Oncology, Cardiovascular and Neuroscience experience
- Experience with buy and bill physician administer specialty products
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Reimbursement Manager Neo Resume Examples & Samples
- Develops, evaluates, implements and maintains policies and procedures to ensure standard operating procedures are adhered to with regards to deposits and payments received and collected on underpaid and/or unpaid accounts
- Oversees the training of staff on proper processing practices, billing data systems, and payer regulations as pertinent to the employee’s position
- Manages the work flow to adhere to the published accounting production schedule
- Maintains internal controls as set forth by senior management and audit
- Ensures production requirements are met as they relate to monthly deadlines established by senior management
- Prepares reports, statistics and surveys relating to collections, DSO, account receivable, third party payer issues and trends, department performance and their financial impact as requested
- Keeps Director abreast of any changes in reimbursement that may affect initial billing procedures, and works closely with Director to continuously monitor department performance
- Interviews, hires, on-boards and performs evaluations of assigned staff and recommends merit increases, promotions, and/or corrective actions
- Motivates employees to achieve peak productivity and performance
- Utilizes continuous quality improvement processes to improve and maintain quality results
- Identifies trends to allow for training, development and continuous process improvement utilizing Lean tools and principles
- Participates in development and implementation of objectives, short and long term planning and goals, as well as projects and programs to assist in accomplishments of established goals
- Maintains confidentiality of all Protected Healthcare Information as defined by HIPAA
- Demonstrated leadership abilities with multiple teams in a healthcare billing capacity
- Strong communication skills among team, corporate office, and senior management in all areas
- Bachelor's degree (B. A.) from four-year College or University and 3 or more years of related experience with at least 1 year in a supervisor or manager position; or equivalent combination of education and experience
- MS Office Suite
- Healthcare Billing System (AS400 preferred)
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Reimbursement Manager Resume Examples & Samples
- Supervising employees in a diverse public sector organization
- Managing third party billing and reimbursement
- Accounting experience in a large, complex local government or public agency
- Certified Professional Biller (CPB)
- Certified Professional Coder (CPC)
- Experience designing or developing administrative and accounting systems to implement policies and procedures
- Experience developing audit plans and conducting audit reviews for a local government agency
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Access & Reimbursement Manager Resume Examples & Samples
- Manage top hospital/hospital system (Commercial or VA/DOD/Government), oncology network, specialty pharmacy accounts (as needed) within defined geographical region of the US
- Hit or exceed account MBO goals on a quarterly and annual basis
- Develop Administrative clinical and C-suite relationships
- Add business value to current and projected product spend
- Validate that account has adequate charge-master set up and payer reimbursement
- Working with the Oncology Hub to resolve or prevent account issues related to proper coding, billing, denials, and revenue recovery related to product coverage and reimbursement
- Communicate and facilitate payer information updates to accounts when necessary
- Assist in getting key products on formulary where needed
- Assist with resolving distribution access issues
- Develop customized solutions using corporate resources and/or outside consultants
- Collaborate with Corporate Account Management, consultant and vendor teams on specific payer or charge-master account issues
- Support spend and price justification with senior account management
- Demonstrate effective account management and customer service skills
- Excellent communication, written and verbal skills
- Excellent Analytical capabilities for business presentations and quarterly reviews
- Assist in managed markets training and development of the OAM’s
- Quarterly face-to-face meetings with the Director, Access and Reimbursement – Heme/Onc
- Assist Director, Access and Reimbursement Heme/Onc , with special projects and priorities, as needed
- Reports to the Director, Access and Reimbursement Heme/Onc
- Hospitals/Systems, Oncology Networks, Specialty Pharmacy
- Payers, Government (Medicaid, Medicare, VA, DoD, etc.), Wholesalers
- Internal Partners
- Regional Sales Manager
- Oncology Account Manager
- Thought Leader Liaisons
- Corporate Accounts
- Trade and Channel Accounts
- Senior Management
- Minimum 2 years Reimbursement/Access experience (Oncology preferred)
- Minimum 2 years of account management and/or managed markets experience (preferred)
- Oncology Specialty Pharmacy experience (preferred)
- In depth understanding of Hospital/Institution Revenue Cycle Management (preferred)
- In depth understanding of Payer policies (preferred)
- Industry Experience: Total 10 years Candidates for this position may be located in the state or states surrounding the location noted in this posting
