Reimbursement Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the reimbursement job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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E Herman

Eduardo

Herman

440 Klocko Field

Boston

+1 (555) 473 9974

440 Klocko Field

Boston

Phone

p +1 (555) 473 9974

Experience Experience

Dallas, TX

Resources & Reimbursement Agent

Dallas, TX

Reichert, Morar and Dicki

Dallas, TX

Resources & Reimbursement Agent

Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov
Function as a subject matter expert and provide technical assistance to Bureau staff on various Federal benefit programs such as Medicaid, Supplemental Security Income, Social Security Administration, Medicare Savings Programs, Food Stamps, etc., or on payment funding sources for various OMH operated programs/living arrangements such as Outside Hospital Care, State Operated adult and children’s residential programs
Perform billing account management; and ensure assignments for projects, workgroups and committees are brought to a successful conclusion
Possess knowledge in the use of reference resources (e.g. Federal and State laws, regulations, policy/procedural manuals, Commerce Clearing House, publication/on-line system, etc.)and perform research and analysis for Bureau managers
Provide supervision to clerical staff and manage the office in the absence of the Office Manager
Function as the liaison with private agencies, other governmental units, the local DDSOO, DDRO, other OPWDD staff, advocates and individuals served by the agency
Coordinate benefit applications, ensure eligibility for programs is maintained, all entitlements are secured and any denials are correctly appealed; and maintain office workflow

Detroit, MI

Manager Reimbursement

Detroit, MI

Reilly-Brekke

Detroit, MI

Manager Reimbursement

Assist hospitals to prepare and review contractual adjustments budgets
Prepare annual and final external audit workpapers. Communicate issues to both the reporting and division managers
Critically review proposed adjustments to cost reports and decide, along with the Director and Managing Director, which adjustments should be appealed
Assist the Administrative Director of Reimbursement in preparing the Hospitals’ strategic planning module
Assist staff in meeting deadlines and monitor the department’s quality plan
Revise data elements used to compute contractual adjustments based on the latest annual cost report and
Assist the independent auditors in their annual review of the third party reimbursement area

present

Chicago, IL

Director, Field Reimbursement

Chicago, IL

Sipes, Deckow and Fisher

present

Chicago, IL

Director, Field Reimbursement

present

Develop, obtain approval, manage and execute National and Regional reimbursement strategies within budget
Conducts field visits with employees to observe, monitor and provide ongoing coaching, recognition and assessments of performance
Recruit, hire, assign, train and manage performance of (8) Field Reimbursement Associate Directors covering targeted regional accounts
Ensure team has extensive knowledge of individual Managed Care Account's geographic presence/influence, payer mix, product coverage and reimbursement policies
Effectively and efficiently manages resource allocation, including business plans and trade-off decisions across geographies
Coordinate and collaborate with field sales by providing coverage and reimbursement education to prioritized targets
Develops and maintains a master list of access across all payer segments to inform client stakeholders on challenges and opportunities

Education Education

Bachelor’s Degree in Business

Webster University

Bachelor’s Degree in Business

Skills Skills

Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy
Excellent written and oral communication skills
Strong customer service experience
Excellent Interpersonal skills
Ability to effectively handle multiple priorities within a changing environment
Excellent organizational skills
Strong Computer literacy
Vascular experience and knowledge,
Previous field experience,
Account management and project management experience,

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Expense Reimbursement & Invoice Processing Team Member Resume Examples & Samples

Responsible for quality and timely processing of non-PO invoices, PO invoices and employee reimbursement claims
Matching PO invoices to Purchase Orders and managing Purchase Order exceptions. Work closely with Procurement to resolve any PO related issues
Responsible for quality and timely settlement of all CTE employee expense claims
Ensuring that invoice all elements are correctly data entered in the product processor. For example supplier details, address, tax calculations, currency, amount, etc
Become familiar with corporate and departmental policies and procedures: CEMP, CSS, Accounts Payable, etc
Ensure that all Invoices and employee expenses are processed 100% compliant to Citigroup policies and procedures
Able to identify and select Withholding tax and VAT tax codes for the invoices
Troubleshoot Invoice, Employee Expense problems and escalations, solution process issues, and interface with technical support to resolve systematic problems
Decides on rejection of invoices for non-adherence to policies and adequate documentation, therefore deferring processing until the appropriate level of approval or proper documentation is obtained
Ensures that resolution mailboxes are closely monitored and tracked to ensure that response is provided within committed SLA
Participate in ad hoc and special projects on an 'as needed' basis
Excellent MS Excel skills required including formulas and macros
Familiarity with invoice payment and financial tracking systems required
Good communications skills and aptitude for dispute resolution
Experience with corporate billing and financial systems
Strong client focus and ability to step outside regular job functions and comfort zone to assist the global team
Effectively communicates to exchange ideas and complex information and exercises good judgment in sharing sensitive/confidential information
Proactively seeks for solutions and alternatives for better customer experience

Regional Field Reimbursement Resume Examples & Samples

Bachelor’s Degree or equivalent work experience within related position is required (degree is strongly preferred)
Minimum two years’ experience in practice management/or/pharmaceutical industry in reimbursement, clinical support, or sales
Regional subject matter expertise in the area of the liver disease, specifically Primary Biliary Cholangitis
Data analysis skills
General payer policy knowledge including managed care and Medicare/Medicaid
Foundational knowledge of benefit verifications and prior authorization requirements
Knowledge of access processes within the physician office
Ability to review clinical information in patient charts, apply reimbursement knowledge to provide guidance to Health Care Professional offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation
Experience with specialty products (preferably oral products) acquired through Specialty Pharmacy
Specialty pharmacy experience required (ability to teach an office the entire process from script to dispense)
Ability to operate as a “team player” in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
Ability to travel (approx. 50%) and cover large geographical territories
Advanced knowledge of medical insurance terminology
Above average computer skills: PowerPoint, Excel and Word

Director of Reimbursement / Chargemaster Resume Examples & Samples

Excellent benefits with 4+ weeks of PTO
Stable organization
Competitive Base Salary
Bachelor's degree in Accounting, Finance, or related field
MBA or CPA required
Healthcare experience required
10+ years experience and 5+ years management experience required
Must have a strong background in financial analysis and financial modeling
Advanced understanding of Microsoft Excel is necessary, as well as proficiency with health information systems and databases
Must possess proven leadership skills, including setting and managing goals and objectives
Must possess strong analytical skills, excellent oral and written communication skills

Assistant Manager, Reimbursement Resume Examples & Samples

General knowledge of reimbursement and patient assistance programs and database elements and functionality; operational policies and processes particularly distribution processes/interfaces
Health care research and analysis skills sufficient to support payer research healthcare policy library and state management
Ability to resolve associate issues effectively and efficiently
Positive can do attitude
Exhibit a good understanding of ABSG Canada services and client base
Demonstrate a solid understanding of the program support tasks needed to support the daily operations of the corporation
Extremely hands on with team and patient activities
Strong communication skills interpersonal skills and attention to detail
Ability to multi-task and meet established deadlines

Reimbursement Territory Manager Resume Examples & Samples

This position will be supporting customers in New York (Manhattan, New Jersey, Columbus) territory.The desired applicant will already need to reside in the Southeast territory region and near a major airport
Bachelor’s Degree required; degree in Business or Healthcare related field preferred or a minimum of 8 years healthcare related reimbursement experience
Proven presentation skills and experience
Strong Computer literacy
Previous field experience, a plus
Vascular experience and knowledge, a plus

Reimbursement Policy Manager Resume Examples & Samples

Secure appropriate coverage, coding and payment parameters for Sandoz’s products
Develop relationships with key stakeholders within Medicare and Medicaid including: Carrier Medical Directors, Lead Policy Analysts, CAC members, Professional Society Members, State Society and DUR Board members, State Medicaid P&T members, as well as community based thought leaders
Actively share insightful information with Sandoz and NVS SEA stakeholders
Serve as a vital link to managed markets, field sales organizations, marketing and leadership to communicate government payer issues, trends, and needed programs
Develop action specific account plans which identify priorities, obstacles, resources and support programs
Conduct field sales support as necessary to resolve billing and coding issues related to Sandoz products in the Medicare benefits and FFS Medicaid programs
Where appropriate, provide reimbursement subject matter expertise to the Managed Markets team
Performs all job responsibilities in full compliance with our Code of Conduct and all Sandoz policies, and acts as a role model for integrity by visibly and consistently acting the values of our Code of Conduct and championing adherence to all Sandoz policies

Employer & Individual Reimbursement Policy Manager Telecommute Resume Examples & Samples

Functional SME
Broad business approach
CPC Certification or willingness to obtain one upon employment
5+ years experience in commercial reimbursement policy
Experience researching potential policy sourcing avenues including CMS, CPT®, Specialty Societies, and others as applicable
Working knowledge of the UNET claims platform
Intermediate proficiency with Microsoft Excel and Word (Excel will be part of work; able to pivot tables, data files, write simply formulas, subtotals, understand and manipulate data. With Word, involves reviewing and tracking changes, add commentaries, work with documents that are heavily formatted and tables embedded in the document)
Undergraduate degree (or higher)
Knowledge with Fraud, Waste and Abuse recovery concepts
Working knowledge of professional and facility claim reimbursement
2+ years of experience with clinical editing tools in support of reimbursements
Proficiency with One Note and PowerPoint
Experience designing and/or maintaining iCES editing to support reimbursements
Experience managing multiple projects and affordability initiatives simultaneously
Experience with interpreting financial reports and manipulating data
Experience in policy writing (ex: reimbursements, but not limited to)
Excellent presentation skills with the ability to clearly articulate information
Ability to identify business technical solutions for reimbursements needs
Exceptional leadership, negotiation and influencing skills

Reimbursement Policy Manager Resume Examples & Samples

Bachelor's degree in Business or Public Administration, or a closely related field
Three years of supervisory, research or consultative experience in health services, health insurance, health care, social service or Medicaid programs
Expert personal computer/office machine skills required. Advanced skills for Microsoft Excel. Intermediate skills for Word and PowerPoint
Excellent negotiation and facilitation skills, with the ability to work with skilled professionals performing complex tasks. Tasks may include policy development and implementation, FQHC and RHC reimbursement and billing, and payment mechanism operations
Experience with ProviderOne system desired
Knowledge of medical terminology and provider specialties
Knowledge of Medicaid and Medicare payment policies
Knowledge of federal Medicaid and Medicare statute (USC) codes (CFR), Medicaid State Plan, state laws (RCW), and regulations (WAC) that pertain to reimbursement and qualifications for Medicaid reimbursement

Reimbursement Policy Manager Resume Examples & Samples

It is highly preferred that the candidate lives in the metropolitan DC, PA, NY, NJ, MA or CT. area
Minimum of 7 years industry experience required
Minimum of 3 years of field-based experience in the pharmaceutical industry with a proven track record as a field reimbursement manager (State Government Affairs Manager, Reimbursement Account Manager, etc.) working with biotech injectable products
Must have in depth understanding of coding, coverage and payment for oncology therapies across all sites of care (hospital, clinic, integrated delivery network)
Oncology injectable, buy-n-bill product reimbursement experience preferred
Experience working with key oncology stakeholders preferred
Proven analytical skills and ability to develop customer specific strategies to reduce reimbursement barriers
Strong communication skills, both verbal and written, including presentation skills
The geography for this position will be aligned to the Medicare Administrative Contractor jurisdictions for the following states: NJ, NY, RI, CT, VT, NH, MD, PA, DE, MA, ME & Washington DC

Manager of Reimbursement Resume Examples & Samples

Bachelor's degree in business or a related field (a CPA, MBA, MHA and/or MPH is a plus)
5+ years of relevant, in-depth health care experience with a professional services firm, a regional firm, a large acute care, or an academic medical center
Candidates with less experience will be considered for a Senior Consultant level
Proven track record in professional services business development in the acute healthcare industry
Extensive knowledge of Medicare/Medicaid reimbursement principles and compliance reporting, including billing compliance, cost reporting, Graduate Medical Education (GME), Medicare Bad Debt, Wage Index, Organ Acquisition, and Disproportionate Share (DSH), and knowledge of applicable regulations, reimbursement principles, laws, and proposed legislation
Experience conducting Medicare/Medicaid appeals and disputed issues on behalf of hospitals; experience preparing position papers and knowledge of Provider Reimbursement Review Board (PRRB) proceedings preferred

Reimbursement Director Resume Examples & Samples

Direct oversight of Field Reimbursement Managers - recruit, interview and hire team
Reimbursement (coding, coverage any payment policy) expertise on manufacturer products in all places of service (POS) under medical benefit (buy/bill)/Part B required
Provide reimbursement support to physicians and billing/office managers including knowledge of billing and coding systems
Identify prospective opportunity or coverage issue and support a central patient centric HUB / patient services assisting with out of pocket help from multiple areas
Assist key accounts to overcome access barriers for key client stakeholders and support access to infusion at each site of care, HOPD, Clinic and Home Infusion
Educate Reimbursement and Site of Care Coordinators to provide alternative financial support options (co-pay, rebate, foundations and PAP) to institutions and provider offices to assist patients in unencumbered access
Support both institutional and individual provider customers with reimbursement models by utilizing an in depth understanding of Buy and Bill, Assignment of Benefits and Medicare Part B options for reimbursement
Implement initiatives for critical payer accounts and their contracted specialty distributors and other critical payer prospects
Work with sales force to identify key physicians to help implement a strategy to positively influence payer decision
Provide case updates and coaching to their assigned sales teams of 8 members 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
Requirements
Bachelor's degree required, advanced degree or specific practice management experience preferred
Minimum of 8 years in reimbursement, contract strategy, managed care sales, Part B/ Medical benefit experience required
Experience working with a patient centric HUB
Minimum of 3 years in management capacity required
Previous market access management experience preferred
Specialty Distribution, Infusion, and buy/bill product experience desirable
Past success in launching products and execution of launch strategies and plans

Senior Manager, Field Reimbursement Resume Examples & Samples

Responsible for day to day operations, performance management, training, coaching, mentoring, and issue resolution for a team of field based employees. Participates in recruiting and hiring activities
Conduct field visits with field employees to observe, monitor and provide ongoing assessments of performance
Communicate and coordinate team efforts with local sales representatives, MSLs, Market Access Managers, and other corporate support, as part of a collaborative team. Work closely with client's access teams to identify and develop specific strategies and tools to meet the needs of the customer
Attends and participates in sales meetings, training classes, seminars, conventions, and other business activities as needed. Build positive customer and client relationships
Develops and executes geographical based strategic and tactical plans to meet customer and business needs
Partner with key commercial and market access personnel to target customers and drive appropriate and compliant influence as it relates to client's product and services
8+ years of field program management experience. 7-10 years of relevant Specialty, Pharma and/or Reimbursement experience preferred
Current, unrestricted driver’s license in state of residence
MS Office Applications – Word, EXCEL, PowerPoint, Outlook; Multi-user computer systems
Experience working/leading cross-functional teams to coordinate and execute plans and projects. Established record of consistent achievement of goals and objectives; Demonstrated track record of influencing, negotiation and presentation skills. Demonstrates an in-depth knowledge of the market; Experience in targeting, developing and maintaining a customer base; Experience in building customer relationships with key organizations, targeted accounts, and other identified key customers. Demonstrated customer literacy and the ability to interpret market access data; Ability to develop, analyze, interpret, and report regional coverage, access & reimbursement trends. to the customer. Demonstrates knowledge of specialty product channels and specialty product distribution; Ability to serve as a technical and clinical resource to the internal and external teams

Executive Director, Access & Reimbursement Resume Examples & Samples

Develop, maintain, and effectively communicate a thorough understanding of the complex and rapidly evolving factors influencing reimbursement/patient access to products in the US specialty market (including personalized medicine/molecular diagnostics, reimbursement trends, payer concerns, provider business issues, dispensing physicians, 340B hospitals, accountable care organizations, pathway initiatives, patient co-pay and coinsurance concerns, compedia policies/guidelines, and private and public policy issues) to lead development of reimbursement and access strategies for BI specialty products
Collaborate with colleagues in other groups in Market Access, Marketing, Sales, HEOR, MAPOR, Analytics & Insights, CDMA, DRA, Patient Advocacy/Professional Relations, Government Affairs/Policy and plans and gain appropriate approvals for implementation
Hire, train, and develop staff (3 direct reports: Director Reimbursement Access, 2-3 Director, Area Reimbursement, and 20 Area Reimbursement Managers) necessary for optimal access and reimbursement at launch and throughout product life cycles. Work with Payor Sales, HEOR, FBM, Trade, Specialty Sales, and Specialty Strategic Accounts colleagues to coordinate activities of Specialty Area Reimbursement Managers with other customer facing BI teams to optimally meet the needs of payers, providers, patients and other stakeholders to insure appropriate access to BI specialty products. Manage department budget and contribute to achievement of specialty LTF goals
Co-lead the development with marketing teams and lead the implementation of BI's "best in class" Specialty Access and Reimbursement Plan, including reimbursement hot line, patient assistance program (PAP), co-pay assistance program, patient support/AE management program. Monitor and benchmark services and performance to maintain quality and competitive advantage
Support maintaining of productive relationships with relevant specialty external stakeholders, including the Association of Community Cancer Centers (ACCC), the American Society of Clinical Oncology (ASCO), the Community Oncology Alliance (COA), the National Comprehensive Cancer Network (NCCN), as well as various specialty pharmacies, group purchasing organizations, pathways companies, payers and other stakeholders necessary to understand customer needs, anticipate shifts in market conditions, and help to shape the debate in emerging specialty polity issues
Effectively support contracts with specialty pharmacy/distribution partners to ensure that drive desired performance
Availability of data necessary to fine-tune targeting strategy and field force incentive compensation
Maximize access to BI specialty products for the patients who need them
Allow for a competitive advantage for BI through positively influencing perceptions of specialty stakeholders
Contribute to the overall strategy, direction, and culture of the specialty franchise at BI through role and senior members of leadership team. Provide timely and relevant input regarding complex reimbursement issues to help prioritize and shape future specialty development programs through active participation in the specialty Therapeutic Area Strategy Team (TAST) as appropriate
Clinical experience (nurse/nurse educator, pharmacist, clinical monitor/MSL, etc.) not required but helpful. Experience with oral targeted therapies strongly preferred; lung cancer market experience helpful but not required

Reimbursement Territory Manager Resume Examples & Samples

Identify need, schedule and execute on travel throughout territory
Work in concert with manufacturer’s field sales team best support territory
Work in concert with manufacturer’s patient support center on patient case management
Assist in the completion of backlog casework and move pending reimbursement cases through to conclusion
Monitor territory’s performance through analysis of reporting, customer relationship management system and conversations with practices and manufacturer’s field sales
Identify any issues detrimental to territory performance and create strategies for resolution
Research and compile provider / manufacturer representative-specific information for reimbursement database. (Includes account profiles)
Utilize internal resources to proactively address areas of opportunity related to the overall customer experience
Utilize performance tracking tools & survey
Additional day-to-day in-office work
Client facing customer experience

Manager Employer & Individual Reimbursement Policy Telecommute Resume Examples & Samples

Company thought leader
Develops pioneering approaches to emerging industry trends
CPC Certification
5+ years’ experience in commercial physician reimbursement policy and claims editing adjudication
Working knowledge of CMS methodology, specialty societies, third-party sourcing, and contracting strategies affecting policy exceptions
2+ years of experience with clinical editing tools in support of reimbursement policy
Experience writing business requirements
Proficiency with Microsoft Excel (data entry, sorting, creating/modifying spreadsheets), Word (data entry and documentation creation), OneNote (basic content creation for use as virtual notebook) and PowerPoint (presentation creation)
Previous management (with direct reports) experience
Experience in project management, Lean and/or Six Sigma philosophies
Working knowledge of any of the following claims platforms ( UNET, ppoONE, Facets, NDB or Cosmos)
Experience developing data parameters and interpreting financial reporting results
Experience designing and/or maintaining iCES editing, CES editing, robots, SAM edits or other implementation strategies to support reimbursements
Familiarity with maintaining policy exceptions
Ability to build cohesive relationships, working across departments
Exceptional innovative thinking skills
Excellent verbal and written skills with the ability to clearly articulate information in a concise manner

Resources & Reimbursement Agent Resume Examples & Samples

Investigate and determine potential eligibility or continued eligibility for all benefits and assistance available to individuals
Develop benefits and entitlement; protect and preserve assets and continued eligibility for benefits
Maximize reimbursement by establishing charges and arranging payments
Communicate with Revenue Support Field Operations, other State and Federal agencies, community agencies, individuals, their relatives and other advocates

Medicaid Reimbursement Team Leader Resume Examples & Samples

Provide guidance, oversight, training and development for a team of 5-7 Medicaid Reimbursement Specialists
Solve complex problems
Work with minimal guidance; seek guidance on only the most complex tasks
Provide explanations and information to others on difficult issues
Coach, provide feedback, and guide others
Act as a resource for others with less experience
In depth knowledge of United Healthcare claims processing systems (COSMOS, DIAMOND and FACETS)
4+ years facility (i.e. hospital) reimbursement methodology (i.e. AP-DRG, CMS ASC, etc..) knowledge
3+ years of experience researching government regulations
Intermediate proficiency in MS Office (Excel, Word and PowerPoint)
Previous mentoring or team lead experience an asset
Ideally regulation research experience is within healthcare field
5+ years of experience in healthcare claims, contracting, or provider reimbursement methodology
5+ years of Medicaid reimbursement experience
5+ years of facility (i.e. hospital) reimbursement methodology (i.e. AP-DRG, CMS ASC, etc.) knowledge
3+ years of experience in project management
In depth knowledge of United Healthcare claims processing systems (COSMOS and FACETS)
Undergraduate or higher level degree
Experience with clinical editing tools in support of physician reimbursement policy
Excellent verbal and written skills with the ability to clearly articulate complex or technical information in a clear and concise manner
Ability to effectively multi task, effectively managing multiple projects and initiatives
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Ability to understand and interpret complex information from others including but not limited to reimbursement policies standards
Exceptional organizational skills and negotiation skills
Ability to effectively communicate with senior management levels
Ability to facilitate meetings with multiple levels of management
Ability to develop and maintain policy and procedures or training material documents
Ability and willingness to work toward team objectives and work well with others

Reimbursement Team Lead Resume Examples & Samples

Coordinate and facilitate all aspects of the timely billing for a defined set of locations and payers and clients
Works with assigned branches to obtain necessary documentation to process billing in accordance with payer and/or company guidelines
Submit electronic and manual claims adhering to strict deadlines
Manages unbilled report to ensure all billing for assigned areas is processed
Files supplemental billing for any late entries within payer filing limits
Provide billing guidance and support to the branch locations
Review accounts receivable reports regularly for any problematic accounts/payers, trends and ensures timely follow up
Work with payer and branches to reach resolution on any unpaid claims
Completes write offs/adjustments for uncollectible AR and routes as appropriate timely for approval
Maintain optimal communication and rapport with payers and branches
Offer input and maintain reporting requirements relative to assigned accounts
Identify and notify supervisor of changes in payer guidelines
Knowledge of governmental payer requirements (i.e., Medicaid, Managed Care and Long Term Care) a plus
Solid history of proven success with Accounts Receivable
Advanced computer proficiency including Microsoft office
High level interest in being part of a dynamic and growing team
Ability to work independently and meet critical deadlines
2) Good follow up skills
3) Strong attention to detail
4) Good communication skills

Director, Field Reimbursement Resume Examples & Samples

Develops and executes a national strategy and monitors the execution of regional tactical plans to meet customer access and reimbursement needs
Leads the effort to build the team, define the culture and shape the future direction of the Field Reimbursement Team
Develops SOPs and responsible for their successful execution
Provides direct oversight to all field reimbursement managers and staff for performance management, training, mentoring, and issue resolution. Actively participates in recruiting, developing, training and coaching the field reimbursement team
Works to insure field alignment is optimized to meet customers’ needs
Develops and maintains a master list of access across all payer segments to inform client stakeholders on challenges and opportunities
Conducts field visits with employees to observe, monitor and provide ongoing coaching, recognition and assessments of performance
Attends and participates in internal and external meetings, training classes, seminars, conventions, and other business activities as needed and provides those learnings to team for development
Partners with key internal and external personnel to target customers and drive appropriate and compliant influence as it relates to clients’ products and services
BA/BS degree, MBA preferred
12 or more years of Specialty, Pharma and/or Medical Device experience with 7-10 years of relevant Market Access, Managed Markets and Reimbursement experience
Exhibits and shares a strong understanding of the health insurance industry; ability to navigate and support both public and private insurance/plan requirements; managed care exposure
Understanding of and ability to implement successful management and leadership principles; proven leader in a field reimbursement environment
Superior working knowledge of specialty product channels and a keen awareness of specialty product distribution
Ability to drive results through leveraging effective influence and relationship skills
Experience in policy development and influence
Proven organizational, analytical, and interpretative skills; demonstrated time management
Superior written/verbal communication and presentation skills
Ability and willingness to travel (extensively at times) to meet goals
Strong Computer Literacy: MS Office Applications – Word, EXCEL, PowerPoint, Outlook; Multi-user computer systems
Working knowledge of business financials
LI-TG1

Resources & Reimbursement Agent Resume Examples & Samples

Manage the Western New York Revenue Support Field Office
Identify, develop and deliver training to state and not-for-profit staff, families, advocates and individuals on the management of benefits and resources
Represent the agency in working with federal, state and local benefit agencies to ensure understanding and cooperation in the development and management of benefits and entitlements
Assist families, advocates, individuals and providers in the resolution of benefit and payment issues
Manage Medicaid district responsibilities including all facets of eligibility and Medicaid system coding for proper provider payments

Resources & Reimbursement Agent Resume Examples & Samples

Conduct patient financial investigations to determine source of reimbursement
Assist patients in obtaining Medicaid and other entitlements
Serve as OASAS resource and reimbursement liaison with staff and other agencies
Maximize and track reimbursement through assertive billing and collection
Participate in activities intended to improve patient care and facility operations
May assist remotely with financial investigation of patients for other ATC locations in the surrounding area, as needed
May be assigned other tasks to meet facility needs

Field Reimbursement Territory Manager Resume Examples & Samples

This position will be supporting customers in the Pittsburgh (Pittsburgh, Cleveland, Columbus, and Southwest Virginia)territory. The desired applicant will already need to reside in the Pittsburgh territory region and near a major airport
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
Proven presentation skills and experience
Ability to effectively handle multiple priorities within a changing environment
Strong Computer literacy
Previous field experience, a plus
Account management and project management experience, a plus
Problem solving and decision making skills

Resources & Reimbursement Agent Resume Examples & Samples

Coordinate benefit applications, ensure eligibility for programs is maintained, all entitlements are secured and any denials are correctly appealed; and maintain office workflow
Function as the liaison with private agencies, other governmental units, the local DDSOO, DDRO, other OPWDD staff, advocates and individuals served by the agency
Identify training needs and provide training to nonprofit and RFSO staff; function as systems administrator
Perform billing account management; and ensure assignments for projects, workgroups and committees are brought to a successful conclusion
Provide supervision to clerical staff and manage the office in the absence of the Office Manager

Manager of Provider Reimbursement Resume Examples & Samples

May oversee work activities of other supervisors
Ability to lead, develop, support, and organize a team
Undergraduate degree or similar experience
5+ years health plan experience in claims, contracting, or reimbursement
5+ years experience in physician reimbursement policy payment and coding methodologies, including CMS
5+ years experience in project management
3+ years experience managing a staff
Exceptional organizational skills and negotiation skills
Excellent verbal and written skills with the ability to clearly articulate information in a clear and concise manner
Ability to effectively multi task, effectively managing multiple projects and initiatives
Advanced proficiency in MS Office (Excel, Word& PowerPoint)

Reimbursement Case Manager Resume Examples & Samples

Work with healthcare providers and patients to assist with appeal management for claim
5 years experience in the healthcare industry including, but not limited to, Medicare and/or Medicaid program administration, insurance verification and/or claim adjudication, physician’s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers
Ability to effectively handle multiple priorities within a changing environment
Proficient with MS Office (Strong Excel skills preferred)
Proficient with MS Outlook

Resources & Reimbursement Agent Resume Examples & Samples

Perform case reviews; assist staff in handling more complex issues/sensitive family situations; handle complaints from clients/providers; and perform case work for most difficult cases
Knowledgeable in the eligibility and application requirements for the Social Security, VA, Medicaid, Medicare , and other State and Federal programs. In addition, understand the carve in of behavioral health into managed care and provide guidance on this new complex billing process
Serve as primary liaison for facilities served by this office , with provider agencies, with local social services districts (LDSS), and with State OMH staff to ensure that applications for various State and Federal programs are filed timely and eligibility is determined quickly in order to maximize funding for these programs and reduce State expenditures
Provide training and evaluation for Resources and Reimbursement Agents appointed to two year traineeships, Resource and Reimbursement Agent 1s, and other Personnel
Complete required reports and meeting project deadlines; interact with Bureau management; and attend meetings. Attend Facility meetings providing PRO input to these discussions
Supervise professional and clerical staff, including assigning workload, shifting priorities as needed, and ensuring that staff deadlines are met

Resources & Reimbursement Agent Resume Examples & Samples

Perform case reviews; assist staff in handling more complex issues/sensitive family situations; handle complaints from clients/providers; perform case work for most difficult cases
Serve as primary liaison for facilities served by this office, with provider agencies, with local social services districts (LDSS), and with State OMH staff to ensure that applications for various State and Federal programs are filed timely and eligibility is determined quickly in order to maximize funding for these programs and reduce State expenditures
Provide training and evaluation for Resources and Reimbursement Agents appointed to traineeships, Resource and Reimbursement Agent 1’s, and other personnel
Responsible for the timely and accurate completion of required reports, ad hoc reports, and meeting project deadlines; interact with Bureau management; and attend meetings. Attend Facility meetings providing PRO input to these discussions

Director, Field Reimbursement Resume Examples & Samples

Develop, obtain approval, manage and execute National and Regional reimbursement strategies within budget
Recruit, hire, assign, train and manage performance of (8) Field Reimbursement Associate Directors covering targeted regional accounts
Ensure team has extensive knowledge of individual Managed Care Account's geographic presence/influence, payer mix, product coverage and reimbursement policies
Ensure all activities are consistent with all regulations, laws and company compliance policies
Coordinate and collaborate with field sales by providing coverage and reimbursement education to prioritized targets
Identify current and emerging trends in managed care coverage and reimbursement rules, regulations, policies, procedures, benefit and structural designs. Assess implications and develop solutions
Together with in-market peers, develop strategies and action plans to ensure broad and affordable access, the evolution of policy and enhance company leadership position in the marketplace
Monitor and continuously improve deliverables including the strategy, tactical plan, and resources
Effectively and efficiently manages resource allocation, including business plans and trade-off decisions across geographies
Form actionable networks within leadership and executive leadership across key accounts
Coordinate and communicate with cross-functional teams, as appropriate: Sales, Market Access, Marketing, Commercial Operations, Regulatory, Legal, Compliance, Government Affairs, and Medical Affairs
Prepare, analyze, and present team operational reports to brand and leadership teams
Be a strategic and tactical lead within the Market Access Executive Team and aligned partner to influence and maximize commercial capabilities
3+ years people management experience leadingteams, projects, programs and directing the allocation of resources for aField Reimbursement Team
Proven success record in ensuring team activities are consistent with all regulations, laws and company compliance policies
Experience working with Specialty Pharmacies, HUB's, and Managed Care Organizations
Subject matter expert on the complexity of current and emerging trends in National and Regional Account rules, regulations, policies, procedures, reimbursement, benefit, and structural designs. Comprehensive understanding of Medicare Parts A, B, C, D, and commercial insurance
Ability to lead and coach in complex, cross functional teams and build strategic long term partnerships
Exceptional communication skills that include verbal, written, and presentation skills
Demonstrated collaboration skills - accomplishes key objectives through cooperation with other functional groups
Bachelors degree required, Masters degree preferred
Ability to travel 60% percent of the time

Team Lead Medicaid Reimbursement Resume Examples & Samples

Address daily questions/problems of team members (reimbursement specialists) and assist staff in bringing them to resolution
Work with the team members and management to develop Action Plans to organize tasks or address problems
Ensure that all plans written by the team are implemented and reviewed at team meetings
Assist Sales Representatives, Finance Department and other MPCS Managers with issues, questions, and customer complaints
Compile productivity reports and review. Conduct Productivity review meetings with each team member quarterly. Address any productivity numbers that are below the team standard expediently and revisit as warranted to ensure standards are being met
Encourage input from all team members on ideas for growth and improvement of the team
Keep time sheets/monitor vacation time
Conduct monthly team meetings to provide updates on insurances, products and processes
Manage performance management process
Ensure that all Reference Tools are updated and readily available on the Intranet
Identify training opportunities and notify the Training team in order to schedule training for the team
Communicate all to Managers
Create training tools and continuing education programs
Knowledge of Medicaid Insurance policies and procedures

Reimbursement, Access, & Value Director Resume Examples & Samples

Develop and execute RAV strategy for in-line and launch products
Lead periodic brand-specific RAV team meetings (usually monthly) to communicate strategy and to drive alignment and execution
Coordinate pricing and payer contracting oversight process with Organized Customer Team (OCT), Executive Director, Pricing and Contracting, brand and business unit leadership
Collaborate with Access Marketing, to maintain/develop patient support programs for in-line and launch brands
For oncology sales teams, collaborate with brand and training to develop RAV plan of action (POA), tools and training
For OCT, collaborate with Value Marketing team to create brand specific value strategy, data generation, messaging and tools. Collaborate with Segment Marketing to develop payer clinical messaging and tools. Collaborate with Segment Marketing, Value Marketing and training to develop semester POA, tools, and training
Track OCT payer coverage/POA goals and support dashboard activities
Collaborate with training to train oncology sales and OCT new hires
Assist with brand strategic planning and quarterly business reviews
For oncology sales teams and OCT, triage and address RAV related questions and issues
Manage RAV budget
Develop value messages and align with evidence to demonstrate and communicate product value to payers
Conduct qualitative and quantitative pricing studies to formulate price policy and contracting strategy recommendations
Doctorate degree and 4 years of Marketing, Value and Access, or Reimbursement experience OR
Master’s degree and 7 years of Marketing, Value and Access, or Reimbursement experience OR
Bachelor’s degree and 9 years of Marketing, Value and Access, or Reimbursement experience
8+ years of experience in brand marketing, payer marketing, healthcare policy, market access or related fields
Oncology marketing or sales experience
Strategic planning and market research experience
Demonstrated success as a team leader with strong team management skills
Excellent communication skills, including interpersonal skills to foster collaboration and success in a highly matrixed environment; strong oral/written presentation skills
Product launch experience
Experience developing strategies to optimize payer coverage and patient access
Experience conducting situation analysis of external pricing and reimbursement environment and synthesizing relevant information to develop strategic plans
US pricing and access experience in oncology through variety of channels including clinics and hospitals
Experience developing and marketing patient access support programs
Strategic planning and/or experience in product commercialization
Direct payer experience and/or health policy experience

Resources & Reimbursement Agent Resume Examples & Samples

Research and submit repeals for rejected/denied insurance claims for services within stringent time-frames; verifying insurance eligibility
Participate in the development and implementation of statewide policies and procedures surrounding reimbursement activities
Review Resources and Reimbursement Agents work to assure that all existing rules, regulations, laws, standards, OASAS policy and time frames are being met
Prepare documentation, annual reports and special reports as required or directed by Division and Bureau policies
Establish and maintain contacts with Social Services, Health Department and other State and federal agencies to facilitate processing and payments
Keeps updated on changes in state and federal regulations affecting reimbursement. Reviews negotiations and agreements to insure general understanding of agreements governing administration of clients’ resources and charges for care and treatment
Assists in annual reimbursement revenue projection and analyzes reviews and modifies the projection when programs change or when statutory regulatory changes impact on revenue projections. Reviews reimbursement levels at each ATC to include monitoring and benchmarking revenue per bed
Serves as liaison between the ATCs and Central Office staff regarding such matters as Federal reimbursement and disability guidelines
Provides coverage for the Resources and Reimbursement Agent 3s, who oversee all 12 ATCs divided into Upstate and Downstate, in their absence
Internal controls mechanisms for revenue and reimbursement will be implemented and maintained
Insures reimbursement procedures are compliant with all patient confidentiality laws and regulation such as HIPAA and Part 42CFR

Field Reimbursement Mgr-dallas Resume Examples & Samples

Lead account training with key stakeholders on the use of Takeda’s reimbursement and support services, including but not limited to HUB services
Develop in-service training plans for specialty sales in collaboration with sales training
Manage daily activities that are aligned to area level business plans aimed at navigation of access and reimbursement for the specialty portfolio. This would include, but is not limited to, targeting, frequency strategy, resource allocation and communication plan with cross-functional teams
Identify, communicate and resolve reimbursement concerns, specialty pharmacy and other issues with appropriate internal stakeholders, including Sales, Government Affairs, Marketing, Managed Markets and Specialty Channel NAM(s)
Demonstrated excellence in account management, relationship development and account penetration

Medicaid Reimbursement Resume Examples & Samples

Provide guidance, oversight, training and development for a team of 5-7 Medicaid Reimbursement Specialists
Assess and interpret customer needs and requirements
Identify solutions to non-standard requests and problems
Solve complex problems
Work with minimal guidance; seek guidance on only the most complex tasks
Provide explanations and information to others on difficult issues
Coach, provide feedback, and guide others
Act as a resource for others with less experience
3+ years of experience researching government regulations
3+ years experience communicating regulatory information to others
2+ years of experience in physician reimbursement policy payment and coding methodologies, including CMS
Intermediate proficiency in MS Office (Excel, Word and PowerPoint)
Previous mentoring or team lead experience an asset
Ideally regulation research experience is within healthcare field
5+ years of experience in healthcare claims, contracting, or provider reimbursement methodology
5+ years of Medicaid reimbursement experience
5+ years of facility (i.e. hospital) reimbursement methodology (i.e. AP-DRG, CMS ASC, etc.) knowledge
3+ years of experience in project management
In depth knowledge of United Healthcare claims processing systems (COSMOS and FACETS)
Undergraduate or higher level degree
Experience with clinical editing tools in support of physician reimbursement policy
Excellent verbal and written skills with the ability to clearly articulate complex or technical information in a clear and concise manner
Ability to effectively multi task, effectively managing multiple projects and initiatives
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Ability to understand and interpret complex information from others including but not limited to reimbursement policies standards
Exceptional organizational skills and negotiation skills
Ability to effectively communicate with senior management levels
Ability to facilitate meetings with multiple levels of management
Ability to develop and maintain policy and procedures or training material documents
Ability and willingness to work toward team objectives and work well with others

Market Access Manager, Reimbursement Resume Examples & Samples

Translate payor policy changes into concise and digestible communications for various internal stakeholders
Develop reimbursement education, training and resources for sales reps and external customers through effective emails, marketing collateral, webinars, presentations and consultations, including travel as needed
Quantify payor, provider, and patient business relationships to help product development, sales and marketing teams achieve commercial success
Evaluate reimbursement pathways for new and existing products and support changes in Medicare's regulatory landscape to ensure proper coding, coverage and payment
Implement programs to support key reimbursement changes (e.g. competitive bidding, audits, prior authorization, tele-health, and alternative payment models)
Submit PDAC HCPCS coding verification applications and collaborate with product development to obtain optimal coding for new and existing products
Manage, maintain and monitor day-to-day activities of reimbursement hotline to ensure accurate and effective communications
Identify and monitor payor policy issues and trends that threaten and/or enable market access as well as collaborate with the Healthcare Economics team to evaluate and plan campaigns to influence policy changes
Serve as a liaison between the sales reps and key external customers (i.e. physicians, suppliers, and payors) to identify and provide billing and reimbursement support to help drive adoption of products and solutions
Summarize Medicare rules and draft public comments, with supervision, for CMS’ proposed rules

Reimbursement Case Manager Resume Examples & Samples

Work with healthcare providers and patients to assist with appeal management for claim denials
Conduct external research to identify appropriate alternate funding sources for inclusion to the internal resource database for future reference purposes
Ability to effectively respond to escalated issues and complex cases referred from other Reimbursement employees or manufacturer representatives
Proficiency with MS Office & MS Outlook

Senior Manager, Global Reimbursement Affairs Resume Examples & Samples

Creating and maintaining payer relationships
Developing strategic relationships with health benefit consulting firms
Working with the commercial operations team to identify payers with potential issues
Working with senior coverage and payment officers within payer organizations to adjudicate denied claims where appropriate within a larger strategic coverage and payment arena
Collecting data on payer coverage and payment amounts for the product portfolio
Working with the sales and marketing teams to support ongoing efforts to increase payer and employer group education levels
Communicating key messages of clinical, economic and social benefits of DNA Pap and HPV testing to payers, employer groups and women’s groups
Communicating activities and developments of reimbursement group back into the commercial operations organization
Create opportunities for provider education events working through MCOs contracted networks or IPAs

EBO Reimbursement Team Lead Resume Examples & Samples

Team Development
Workflow and Quality Checks
Project Assistance
Team Interfaces
Related Duties as Assigned
Manage a multiple, concurrent tasks
Understand and carry out oral and written instructions
Establish and maintain cooperative working relationships
Analyze problems, identify alternative solutions
Identify and immediately respond to team members concerns and questions
Excellent follow up and follow through skills
Problem resolution skills

Director, Field Access & Reimbursement Resume Examples & Samples

Work with the Sales and Reimbursement leadership teams within REGN and Sanofi counterparts to lead Regional and local strategy for payer and provider access
Develop and execute strategic & tactical field plan for execution of all existing and new product reimbursement initiatives and relevant to defined needs in each respective customer market
Lead all field payer and reimbursement activity support by respective teams

Senior Manager, Reimbursement Services Resume Examples & Samples

Manage the day to day operations of the Reimbursement HUB vendor(s)
Resolve issues with urgency for matters identified by the internal stakeholders and field personnel
Work with Quality Management to operationalize and monitor a Quality Management System for HUB vendor management
Develop and manage all necessary promotional materials for HUB operations – i.e. call scripts, referral forms, fax forms, promotional materials, etc
Develop, operationalize, and measure new or enhanced programs/services to be managed by the Reimbursement HUB vendor(s)
Track and manage reimbursement HUB service levels, quality and operational metrics as well as key business performance metrics
Provide oversight for the reimbursement hub interactions with specialty pharmacies, prescriber offices, and other healthcare providers
Partner closely with brand marketing and IT counterparts to share performance metrics and analytical insights from Case Management / Decision Support System to manage service performance
Proactively manage response to internal (e.g., service changes) and external drivers (e.g., payer/government policies) and events
Assess operating performance of vendor(s) and staffing needs to manage budgets for all related vendor(s) and project(s)
Work with internal cross-functional groups (Professional marketing, Consumer marketing, Legal, Regulatory, Medical and Project Management) as well as external partners (Ad Agency, Digital Agency, Database agency) to ensure integration and consistency of business strategies and regulatory compliance of promotional materials
Collaborate with the Sales Force, Commercial and IT development teams to inform future system enhancements
Work with IT, Pharmacovigilance and Regulatory to ensure compliance with all SQA guidelines

Regional Director of Reimbursement Resume Examples & Samples

Reviews the monthly, quarterly, and annual computations of the hospitals net patient revenue. Analyze critical computations which include contractual, bad debt/charity, and third party adjustments and allowances. Review and assist with year-end analysis as required for external financial statement audit process to help ensure the accuracy of the hospitals’ financial statements
Communicate and explain significant changes in computations noted above on a monthly and year-end basis to hospitals and corporate finance leadership
Assists third party consultants on projects in specified payment areas of the cost reports and other reimbursement areas as needed
Review and at time prepare various financial analyses related to net patient revenue and other third party implications as required by Senior Management
Possess knowledge of current Medicare, Medicaid, and Blue Cross payment rules and regulations. Acts as a technical resource regarding all Medicare, Medicaid and Blue Cross reimbursement issues for all acute care facilities and the long term care facility, HFMC. Participates in the review of actual and proposed changes to government regulations. Ensures compliance with regulations related to third party reimbursement
Strong analytical capabilities and leadership skills required
Ability to work with leaders throughout the system to assess and implement corporate policies and procedures regarding all financial aspects including internal control, compliance and reporting
Experience with data analysis, project management and knowledge management
Weekend work at year end and other peak times may be necessary
Occasional local travel, specifically to corporate offices located in Bolingbrook, Frankfort, Des Plaines, or Chicago
Bachelor's Degree with major in Accounting, Finance, or Mathematics. CPA / MBA preferred
Five years of experience in healthcare setting including General Ledger Accounting, Payroll, internal audit, financial analysis, financial information systems. Public accounting experience preferred
Strong management/supervisory skills
Thorough knowledge and understanding of third party reimbursement principles and regulations is required
Strong knowledge of US GAAP, internal controls and financial reporting required
Experience with financials of multi hospital systems preferred
Proficient with Medicare/Medicaid cost reporting software
Ability to use healthcare information systems, such as EPIC and Meditech
Knowledge of Revenue Cycle Analytics (RCA), an account receivable software tool, is preferred

Senior Reimbursement Services Manager Resume Examples & Samples

Minimum 7+ years’ experience in the healthcare reimbursement field
Medical Device experience a must
BS degree in relevant field required
Medicare and Private payer reimbursement changes
Knowledge of Federal legislative processes and politics affecting reimbursement
Strong working knowledge of the reimbursement processes affecting HHS products and services – eg. the coverage, coding and payment processes within CMS (Centers for Medicare and Medicaid Services) and other third-party payers
Strong working relationships with key industry and provider groups / payers
Knowledge of the medical device industry within the context of the overall Healthcare industry
Ability to effectively communicate, influence and persuade through oral or written communications
Ability to work collaboratively with others to reach consensus leading to market access

Director, Field Reimbursement Resume Examples & Samples

Three to Five years of Biotech or Pharmaceutical Field Leadership experience
Two to Four years’ experience in the Respiratory Biologics therapeutic area
Three to Five years of Managed Markets/Field Reimbursement experience
Experience with business planning and market analysis
Experience in implementing reimbursement related programs and advisory programs
Does not compromise ethics or integrity to achieve business goals
Clearly demonstrates leadership among peers by consistent application & modeling of appropriate compliance, behavior & conduct
Reimbursement & Access Services Related Experience
Experience with physician administered injectable
Knowledge and experience of legal and regulatory requirements related to the Biotech & Pharmaceutical industries
Director, FRM’s spends majority of time in the field providing Development, Planning, & Support to Field Reimbursement Team (minimum 60 to 75% overnight travel)
Works closely with Access Service, Marketing, and various Managed Markets and Trade groups to review/understand relevant franchise and managed care business plans, goals and objectives
Spends considerable time and effort helping to identify reimbursement-specific opportunities or issues, as well as educating internal partners on the payer landscape
Maintain a high level knowledge of Managed Care and related Managed Markets benefit structures, reimbursement mechanisms, legal and regulatory landscape, and health management programs
Maintain a high level of industry awareness
Maintain an outstanding level of Therapeutic Area knowledge, utilization management techniques, and treatment and reimbursement guidelines
Maintain an outstanding level of performance metric analytics
Maintain a comprehensive and detailed region business plan
Maintain an outstanding ability to prepare and present provider level communications
LI-MEDI

Resources & Reimbursement Agent Resume Examples & Samples

Function as a subject matter expert and provide technical assistance to Bureau staff on various Federal benefit programs such as Medicaid, Supplemental Security Income, Social Security Administration, Medicare Savings Programs, Food Stamps, etc., or on payment funding sources for various OMH operated programs/living arrangements such as Outside Hospital Care, State Operated adult and children’s residential programs
Monitor changes in programs and prepare policy and procedure directives/manual updates for Bureau staff
Interact with staff from outside agencies such as Social Security, State Department of Health, Office of Technology and Office of Temporary Disability Assistance, and voluntary childcare provider agencies
Possess knowledge in the use of reference resources (e.g. Federal and State laws, regulations, policy/procedural manuals, Commerce Clearing House, publication/on-line system, etc.)and perform research and analysis for Bureau managers
Possess knowledge in the use of all computer programs accessed/utilized for Bureau work and monitor and/or perform various operational functions using these programs
Act as the in-house help desk and security administrator for certain systems, including add/deleting users and resetting passwords; processing system reports, and responding to questions from field staff regarding use of certain programs

Manager, Reimbursement Resume Examples & Samples

Minimum of a Bachelor’s Degree in Finance, Accounting, or related field (Master’s Degree preferred)
Prior Work Experience: At least 3 years hospital Reimbursement managerial experience including employee supervision responsibility and/or 8 years of hospital Reimbursement experience
Software/computer experience necessary including financial spreadsheet/database and CMS 2552-10 applications
Supervisory and project skills

Director, Reimbursement & Policy Resume Examples & Samples

Lead Otsuka’s U.S. efforts to analyze and understand Medicare/Medicaid and private payer reimbursement methodologies
Design and execute comprehensive strategies to deliver on a range of Medicare, Medicaid and other health care access policy and reimbursement goals
Identify regulatory opportunities and threats, analyze their impact, and develop and lead strategies to advocate for and achieve desired results
Direct and implement policy and reimbursement strategies and programs to obtain coverage, coding and payment for government payers
Provide US policy and government reimbursement-related analysis and advice to internal business team and leaders
Identify government policy opportunities and/or issues/barriers and develop legislative, regulatory and advocacy solutions to address them
Develop legislative and regulatory comment letters
Create and deliver analyses for Otsuka federal and state lobbyists, business leaders, and trade associations that increase access to the organization’s products and therapies
Develop and ensure that Otsuka has consistent policy positions and provide direction to relevant parts of the business to ensure they are informed and have input into the policy process
Collaborate with sales & marketing, managed markets, commercial, medical affairs, legal, corporate communications and other internal customers to provide insight on health policy developments. Collaborate with and assist internal stakeholders in the preparation of comments on draft guidance, legislation, rules and regulations proposed by government healthcare agencies
Represent Otsuka at various trade associations and work groups
Develop reimbursement strategy recommendations for current products and pipeline
Ensure active collaboration and impact, pre- and post- market, for new product launches in order to ensure as favorable an environment as possible. This includes identifying specific opportunities to support the brands, the business, our customers, and the patients we seek to serve and active leadership on new product launch committees
Monitor and track federal and state level health reforms, expansions, and legislation
Bachelor’s degree or equivalent plus a minimum of 8-10 years of pharmaceutical, or experience with a patient services provider or specialty pharmacy
Demonstrated knowledge of the U.S. healthcare systems, including expertise in health care financing and reimbursement policies related to the biotech/pharmaceutical industry
Must be a creative, flexible and entrepreneurial thinker capable of developing relationships and facilitate partnerships with industry peers, government officials, and other external stakeholders to reach public policy goals
Must possess strong analytical, critical thinking and interpersonal skills, the ability to speak and write persuasively and with clarity, strong organizational skills, flexibility and adaptability to changing requirements, resourcefulness and creativity, strong attention to detail, a proven track record of being able to work under deadlines and an ability to work collaboratively in a fluid organizational environment
In-depth knowledge and/or management of patient access services programs, specialty pharmacy distribution, payers, and patient assistance programs
Demonstrated leadership on issues related to healthcare reimbursement
Possess well-honed political sensitivities and impeccable integrity while having the executive presence necessary to deal effectively with high-profile stakeholders such as elected officials, executives and a variety of external constituencies including governments and third-party organizations
Must be able to work well in a team environment, handle ambiguity well and enjoy working in a collegial, yet highly demanding culture
Track record of successfully managing vendor relationships. Strong financial acumen and analytic skills
Experience in launching new products or indications
Ability to work effectively with cross-functional stakeholders
Strong verbal and written communication skills
Ability to rapidly assimilate information, prioritize and manage to timelines
Strong interpersonal skills
Excellent analytical (qualitative and quantitative), strategic thinking, creativity and problem solving skills
Ensure compliance with all OAPI policies and procedures
Highly proficient in Microsoft Office

Manager Reimbursement Resume Examples & Samples

Work closely with Medical College of Wisconsin and Children’s Specialty Group. Monitors the appropriateness of coding, documentation and charge capture process. Assists with the resolution of problems with respect to coding and documentation
Coordinate and monitor activities with respect to: clinic charge capture reconciliation, offsite charge capture, pre-authorization activity, insurance updates, encounter forms etc. Reimbursement Manager acts as a resource for insurance and/or coding questions
Act as liaison with affiliate hospitals’ registration, charge entry staff, reimbursement team, collections department, physicians and medical records to ensure maximum charge capture, billing and collections for services. Attends meetings, discusses issues as needed and assists with resolution of interdepartmental billing problems as needed. Assists in the development of improvement initiatives for any issues that are identified
Monitor and follow-up on invoices through review, investigation and communication with the reimbursement team, billing specialists and other departments
Prepare monthly reports as decided upon by the department, monthly write-off reports and ad hoc reports and physician logs. Conduct audits when necessary
Monitor weekly charge/payment reports to ensure appropriate work and cash flow for the services
Monitor trends and assist with the resolution of billing problems in order to decrease the number of write-offs and increase collections
Provide on-going training/education for staff physicians, residents and clinical support staff regarding professional charges, coding, use of modifiers, documentation, processes and reimbursement
Assist with billing related activities such as patient billing questions. Attends billing meetings as needed. Participates on billing committees as needed
Complete special reimbursement projects as needed such as ordering reports for providers and research as needed

Manager Reimbursement Resume Examples & Samples

Prepare Medicare and Medicaid cost reports to obtain all amounts due from these programs
Prepare accounting entries to record the cost reports
Review hospital's monthly contractual adjustment computations for accuracy and compliance with policies
Operational changes and answer questions as need be
Supply fiscal MAC auditors with data and support used to prepare cost reports and answer any questions regarding the cost reports
Critically review proposed adjustments to cost reports and decide, along with the Director and Managing Director, which adjustments should be appealed
Assist hospitals to prepare and review contractual adjustments budgets
Prepare annual and final external audit workpapers. Communicate issues to both the reporting and division managers
Serve as a resource on reimbursement matters to hospital personnel

Director of Field Reimbursement Resume Examples & Samples

Provides expert guidance on all facets of access services to ensure that all aspects are aligned to protect both the patient’s and Valeant’s interests
Consults with stakeholders to develop and execute exceptional total solutions that exceed mutual current and unmet or unrealized needs that bring value to all parties
Models and coaches others to effectively convince internal and external stakeholders to adopt difficult positions, build mutual alignment, and achieve win-win outcomes
Provides analytics guidance and support, including defining analysis plans, synthesizing analytic findings to share insights that improve understanding and uncover new opportunities
Leads the field business planning process to ensure the alignment of stakeholder and organizational commercial strategies and a focus on results
Leads the delivery and creation of innovative and tailored communications and presentations that educate and mobilize critical stakeholders
Bachelor’s degree mandatory, along with a track record of appropriate sales experience (see below) and operating with the highest degree of integrity within compliance guidelines. Master’s degree or additional advanced education/certifications a plus
12 years of experience in pharmaceutical sales and or marketing, minimum 7 years of experience in market access necessary

Reimbursement Administrator Resume Examples & Samples

Strong and proven analytical skills and ability to manipulate data in Excel
Intermediate to Advanced Excel software skills
Ability to create models to demonstrate Return of Investment (ROI) using labor, vendor costs and outcomes
Basic to Intermediate Power Point skills
Proven ability to lead meetings, i.e. divisional staff meetings

Manager, Access & Reimbursement Platforms Resume Examples & Samples

Build strong internal/external relationships amongst cross-functional groups and partners (Marketing and other teams, Legal, Regulatory, Medical and ProMo, BTS, brand and other agencies) to ensure integration and consistency of business strategies and regulatory compliance of promotional materials, namely HCP facing websites to support the patient Rx process for both Immunology and Oncology brands
Collaborate with the Sales Force, Customer Solution Specialists, Business Technology Solutions, Marketing Analytics and Business Insights teams to gain insights to inform future system enhancements
Leverage analytics and other data to generate insights about website use to inform future enhancements and decisions
Maintains and demonstrates a deep understanding of brand and customer insights from the patient journey in order to adjust program direction
Demonstrate innovative thinking regarding application of new technologies to marketing, particularly within a regulated environment across channels
Manage projects within identified time and budget parameters
Provides input for the annual brand planning process
Management of external agency budget, personnel and project execution
Develop agency SOWs and provide strategic and tactical direction to support development and execution of projects

Reimbursement Senior Manager Resume Examples & Samples

Possess reimbursement technical skillsets for products such as Cost Reporting, Medicare and Medicaid DSH, Medicare bad debts, and other specialty reimbursement products
Communicate with clients as needed to obtain required information for projects
Learn and develop new technical knowledge specific to our consulting practice and the clients we serve
Prepare, review, and analyze Medicare and Medicaid cost reports
Prepare work papers that provide a trail of the accumulation of client provided information into the prescribed Medicare and Medicaid formats
Perform data collection and analysis utilizing cost reporting data and other client financial information
Ability to multi-task – Able to quickly shift attention among multiple tasks under distracting conditions without loss of accuracy or efficiency
Open to changing situations and opportunities and willingness to perform all tasks assigned
Work either independently or as part of a team depending on the situation
Maintain composure and friendly professional demeanor while dealing with stressful issues
Proven ability to manage personnel along with effective project management
Bachelor’s Degree from an accredited university with an accounting or finance discipline required
Minimum of six years of recent experience in reimbursement consulting
Previous experience in any/all of the following: Hospital including Medicare/Medicaid Cost Reporting, Disproportionate Share reimbursement, Medicare Bad Debt preparation or consulting, or Wage Index specialized knowledge as well as other specialty reimbursement products
Ability to effectively manage client relationships and project work on time and within budget
Good staff relations and ability to effectively communicate with client personnel
Strong working knowledge of Microsoft Excel, Word, Cost Reporting Software
Ability to learn new technology applications including Microsoft access and other software solutions used by the Firm to store and analyze data
Ability to organize significant amounts of information and manage multiple assignments on an ongoing basis

Reimbursement Resume Examples & Samples

Prepares detailed monthly analysis of net patient revenues and accounts receivable
Supports Hospital Director of Finance in reporting monthly revenue variances during financial statement review meetings with Financial Executives
Assists Director, Reimbursement and Manager, Reimbursement with the preparation and filing of Medicare and Medical Assistance Cost Reports
Works closely with external auditors during annual financial audit, including accounts receivable analysis and revenue cycle testing and validation
Works closely with external auditors during Medicare Cost report audits
Prepares monthly various actual vs. budget net revenue analyses
Prepares various monthly financial and statistical reports
Completes special projects as assigned by VP - Finance and Director of Reimbursement / Planning
Other duties as assigned

Reimbursement / Deductions Manager Resume Examples & Samples

Achieves results effectively; results, high performance and process improvement oriented
Develops and encourages cross functional collaboration and effectiveness
Knowledge of SAP, Excel, PowerPoint required
Prior finance and deduction management skills
Working knowledge of Vistex or other credit to cash software strongly preferred
Must possess strong analytical, organizational, presentation skills
Excels in both oral and written communication skills, able to tell stories with data
Influential ability to interact and communicate with all levels in a highly matrixed organization
Proactive continuous improvement and able to implement change as required
Demonstrated ability to lead a team
Prior leadership experience required
Strong interpersonal awareness; able to interact with all levels of management
Project management skills required, active management of projects and initiatives
Bachelor's Degree in Finance, Accounting or Business related field or equivalent experience
5 to 7 years of progressive experience in Finance roles in the consumer product goods (CPG), FoodService and beverage, or dairy industry; exposure and positive interaction with Sales team's is required

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