Field Reimbursement Team Liaison I

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

JOB TITLE: Field Reimbursement Team Liaison I

POSITION SUMMARY

Under the general direction of the Operations Leadership, the Field Reimbursement Team Liaison will serve as the primary point of contact with the client’s field reimbursement team leaders to ensure open communication and resolution for problems in support of eliminating barriers for patients and providers to access therapy. The Field Reimbursement Team Liaison will be responsible for building a team environment with their applicable field counterparts, supporting open communication, performing root cause analysis of issues, tracking issues through to resolution, and ensuring program enhancements, process changes and program updates are shared back to the client’s field teams. They will serve as a patient advocate to the client and the providers to ensure all opportunities for improving patient access can be pursued.

PRIMARY DUTIES AND RESPONSIBILITIES

• Partner with internal and external stakeholders to identify, anticipate and address patient and practice reimbursement issues.
• Be a subject matter expert on the payer landscape related to applicable disease state.
• Ensure processes are in place to drive clear communication with other field-facing teams to ensure clarity of reimbursement and access issues
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Coordinate closely with internal operational program staff and share customer feedback, as applicable.
• Provide coverage, coding, and reimbursement information to key staff members (i.e., practice administrators, reimbursement staff, and providers) to appropriately support patient access.
• Communicate with provider office staff on how to use patient access programs and services.
• Address questions associated with patient coverage, access, and reimbursement from accounts in collaboration and coordination with patient services as directed by policy and procedure.
• Keep abreast of customer and market access industry trends.
• Maintain thorough knowledge of Client’s Product(s)
• Participate as needed in client’s field team meetings to represent the operational program.
• Collaborate, communicate, and integrate closely with the assigned field reimbursement team leaders.
• Prepare reports for management as needed
• Manage ad hoc/urgent escalations as needed; recognize impact and report major escalations and issues to CareMetx Operational leadership and Executive Sponsor as needed.
• Partner with appropriate CareMetx cross functional teams (e.g. training, quality) to identify, develop and provide training for the operational team as needed.
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS

• Bachelor’s degree or equivalent field experience required
• 3+ years of field reimbursement in the Pharmaceutical or Healthcare industries
• 1+ years of leadership experience, preferrable in the healthcare industry
• Proven track record of supporting HCPs and office staff in seeking access/reimbursement that required significant payer and reimbursement support
• Experience with both ‘buy and bill’ and Specialty Pharmacy distribution pathways for specialty oral and injectable medications
• Strong knowledge of the payer environment, including but not limited to: government and commercial payers, assignment of benefits, letter of agreements, accumulators, maximizers, manufacturer financial assistance
• Ability to professionally interact with customers – HCPs, office staff, clients
• Strong knowledge of patient support programs including HUB programs, co-pay assistance programs, and nurse educator support
• Strong planning and organization skills including OFFICE suite of productivity tools

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Ability to communicate effectively both orally and in writing.
• Ability to build productive internal/external working relationships.
• Ability to analyze, interpret, and understand payer, provider, and patient data and trends.
• Strong interpersonal and leadership skills.
• Strong organizational skills; attention to detail.
• Ability to manage multiple tasks.
• Extensive knowledge in areas of reimbursement and billing including Medicare, Medicaid, commercial coverage in medical, pharmacy and office administered products.
• General knowledge of healthcare from a patient and provider perspective (miscellaneous codes, billing codes, appeals process).
• Ability to resolve associate issues effectively and efficiently.
• Ability to proficiently use Microsoft Excel, Outlook and Word.
• Ability to problem solve.
• Willingness to travel up to 10% of the time

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SCHEDULE

• Must be flexible on schedule and hours
• Overtime may be required from time to time

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.