Manager, Field Reimbursement

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: Manager, Field Reimbursement
POSITION SUMMARY:
The Manager, Field Reimbursement is a field-based pharma industry role — this is not a billing, coding, or revenue cycle position.

Under the general direction of Senior Operations leadership/Director the Manager of Field Reimbursement is responsible for the overall administration of the Field Reimbursement program as required by the client contract. The Manager of Field Reimbursement will also serve as a field or home-office based regional expert in payer policies, will handle escalated reimbursement issues and will provide support to healthcare providers to facilitate appropriate patient access and utilization of services to ensure their access to care. hands-on experience supporting specialty providers in a field capacity. Candidates with Ophthalmology and Retina experience are highly sought and strongly encouraged to apply.

PRIMARY DUTIES AND RESPONSIBILITIES:
Monitors employee job performance to ensure that all necessary tasks are completed in accordance with specifications and deadlines
Conducts performance reviews and provides feedback to direct reports
Provides day-to-day instructions to team members on job responsibilities
Helps associates resolve work-related issues
Assist with the hiring and termination process
Assist with the development of program training documents
Ensures open communication with the staff
Proactively identifies program issues and proposes ways in which to address their concerns
Maintains positive rapport with internal and external customers
Understands contract obligations
Analyzes reports for trends and gives recommendations
Interact with key stakeholders within healthcare provider clinics, physician practices, or hospital outpatient locations
Act as a liaison between healthcare provider offices and CareMetx program teams to support complex reimbursement cases
Take the lead on complicated or escalated reimbursement cases in assigned territory, navigating options for both patients and providers to access prescribed therapies
Validate Prior Authorization and Appeal Requirements and communicate as needed to stakeholders
Track electronic payer billing codes for pharmacy and medical payers
Develops Appeal Package for patient support program; ensures communication occurs between stakeholders on status of Appeal, if applicable
Coordinates with patient support program representatives
Assist program teams with handling escalated medical and pharmacy billing challenges
Assist with resolving reimbursement challenges
Provides information on relevant reimbursement topics related to our client’s products
Educate clinics/physician’s offices on patient support program and services
Effectively communicates with patients, family, provider, manufacturer and team members
Provides exceptional customer service to internal and external customers; resolves any customer request in a timely and accurate manner and escalates complaints accordingly
Assist in development of standard operating procedures regarding payer creation, payer database management and prior authorization forms library
Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate
Independently and effectively resolves complex accounts with minimal supervision
Handles complex issues where analysis of situations or data requires an in-depth evaluation of variable factors
Networks with key contacts outside their own area of expertise
Acts independently to determine methods and procedures on new or special assignments
Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results
Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled
Performs related duties as assigned
Qualifications
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
5+ years experience working with specialty healthcare providers for both pharmacy and medical billing (including buy and bill), reimbursement, patient assistance programs, financial assistance programs, and other pharmaceutical reimbursement related activities
Previous 2+ years supervisory experience is required
Technical knowledge of healthcare reimbursement including coding, billing, appeals process, and navigating complex reimbursement issues with both patients and providers
Advanced degree or specific Practice Management experience preferred
Experience in Ophthalmology, particularly Retina, is highly required. Candidates with a background supporting retina practices, anti-VEGF therapies, or ophthalmic buy-and-bill environments are strongly encouraged to apply.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
Ability to communicate effectively both orally and in writing
Ability to build productive internal/external working relationships
Strong interpersonal skills and attention to detail
Ability to manage multiple tasks
Strong analytical skills
Excellent presentation skills
Advanced knowledge of medical insurance terminology
Strong teamwork abilities
Project management skills
Ability to work independently
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes, Pharmacy Benefit design and coverage policy a plus
Strong organizational skills; attention to detail
Ability to resolve associate issues effectively and efficiently
Ability to proficiently use Microsoft Excel, Outlook and Word
Proven ability to appropriately escalate issues to management
Knowledge of private payer, Medicare and Medicaid structure systems and reimbursement processes
Understanding of patient privacy laws including HIPAA and similar state laws
Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory
Ability to travel overnight
Live within 45 minutes’ drive of major airport
Ability to schedule individual work-related travel (air, hotel, rental car as needed)
Ability to utilize own car for travel
Technical knowledge of healthcare from a patient and provider perspective (miscellaneous codes, billing codes, appeals process)
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 accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule:
Must be flexible on schedule and hours.

Some Travel may be required.

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.

Pay: $88,000.00 - $140,000.00 per year
Benefits:
401(k)
Dental insurance
Disability insurance
Flexible schedule
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance
Application Question(s):
1. Do you have experience in a field-based role within the specialty pharmaceutical or biotech industry?

Yes
No
2. This is a pharma field role — NOT a billing, coding, or revenue cycle position. Does your experience align with specialty pharma reimbursement support in a field capacity?

Yes
No
3. Do you have experience working directly with ophthalmology or retina practices?

Yes
No
No but I have other specialty pharma experience
4. How many years of specialty pharma reimbursement experience do you have?

Less than 3 years
3–5 years
5+ years
Location:
Remote (Preferred)
Willingness to travel:
25% (Preferred)
Work Location: Remote