What are the responsibilities and job description for the HUB Reimbursement Manager position at ConnectMed360?
ConnectMed360 is looking for a HUB Reimbursement Manager to join our growing team. We are a unique pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
We offer a variety of benefits including:
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits – life insurance; and short and long-term disability
The HUB Reimbursement Manager will operate as the subject-matter expert on reimbursement, access, and billing/coding/coverage issues affecting the clients’ product. Educate HCPs and their staff on matters related to billing, coding, reimbursement, access, and coverage to facilitate appropriate patient access. Focused on the therapeutic area of Hematology/Oncology, this non-promotional role plays a critical role in offering resourceful support to healthcare systems, institutions, hospitals, and healthcare provider practices.
HUB Reimbursement Manager Major Responsibilities:
- Analyze access/reimbursement issues and opportunities.
- Provide access/reimbursement education to manufacturer field teams, healthcare systems, institutions, hospitals, and healthcare provider practices.
- Coordinate on access/reimbursement issues with third parties.
- Resolve outstanding accounts using various resources to retrieve claims status, medical documentation, and billing guidelines to substantiate revised claim submissions and written appeals.
- Assist offices with how to correct claims and file appeals with supporting documents to insurance companies, by phone, electronically or mail.
- Support patient access to the products by providing subject matter expertise on billing/coding and reimbursement issues that may be barriers to product access.
- Subject Matter Expertise: Serve as the subject matter expert in medical benefit reimbursement, billing/coding and access across all channels (Commercial, Medicare, Medicaid, Government). Educate and identify compliant solutions to address patient access and reimbursement challenges.
- Customer Engagement: Work proactively with assigned customers to build and sustain relationships across key departments, including medication access teams, pharmacy, practice and office managers, and procurement/reimbursement departments.
- Liaison Role: Act as a bridge between customers, patient services, and manufacturers FRM and account management teams to address escalated access and billing issues effectively.
- Performs other tasks as assigned.
Operations Manager Position Qualifications:
- Education/Learning ExperienceWork Experience
- Required: High School Diploma or GED or equivalent experience
- Desired: Associates Degree or equivalent program from a two-year college or technical school, or certificate program in pharmacy or healthcare or equivalent work experience.
- Work Experience
- Required: Minimum of (two) 2 years of billing and coding experience is preferred
- Desired: Minimum of (5) years of billing and coding experience in Oncology/Hematology.
- Skills/Knowledge
- Required: Experience with claims processing, coding and payer contracts in order to process claims and audit payments
- Behavior Competencies
- Required: Team player willing to accept and promote organizational goals and function with minimal supervision.
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