Operational Manager, Reimbursement (Patient Support Services)
- Heredia
- Permanente
- Tiempo completo
- The Manager for Oncology Access and Reimbursement Services will implement the development,
- The Oncology Access and Reimbursement Service model is responsible for serving as a
- Access and Reimbursement Case Coordinator team will independently manage a case load within
- Successfully manage critical conversations with patients, healthcare providers and pharmacies.
- Perform comprehensive assessment of each case to determine appropriate avenue to maximize
- Serve as the Pharmacy Solutions point of contact overseeing the contracted Oncology Access and
- Partner with external Field Reimbursement team to identify additional resources and share current
- Provide guidance through Open Enrollment, including Medicare Part D. Determine eligibility for
- Develop and maintain a localized understanding of market access challenges. Utilize expertise to
- Develop and execute AbbVie Access and Reimbursement Services business plan for accounts in
- Bachelor’s degree in health sciences or business preferred. MBA qualification is desirable. Comparable or relevant experience will be considered.
- 3-5 years’ experience leading reimbursement support teams in a hospital facility or large scale medical office specializing in oncology is highly desirable.
- C1 English Level
- Demonstrate thorough knowledge of reimbursement and access best practices across multiple Patient Access Support options (hospital charity programs, manufacturer patient assistance programs, co-pay card programs, etc.)
- Strong problem solving skills related to complex patient access challenges.
- Experience working with providers to resolve or prevent account issues related to proper coding, billing, denials, and claims appeals related to product coverage and reimbursement.
- Experience educating and mentoring peers and direct reports.
- Experience educating office and hospital staff in reimbursement processes including payer requirements for Prior Authorization, Pre-Determination, Appeals, and Claims submission guidelines.
- Knowledge of Commercial and Medicare reimbursement guidelines and insurance plan reimbursement methodology