Cvs Health Prior Authorization Remote Jobs in Wisconsin

Harrow is seeking a Field Reimbursement Manager (FRM) to serve as the trusted, in-market reimbursement expert for physician practices utilizing Harrow's buy-and-bill drug portfolio across the Retina and Surgical franchises. This individual will provide non-promotional, compliant education on coverage, coding, billing, and claims processes - giving customers the confidence and technical know-how to appropriately access and be reimbursed for Harrow brands.

The ideal candidate is a proactive problem-solver who thrives in the field, builds strong relationships with practice staff, and brings sharp analytical skills to identify and resolve access barriers at the account level. This role is part of a hard-charging, high-accountability team focused on one outcome: expanding appropriate patient access to Harrow therapies.

Customer Education & Reimbursement Support

• Serve as the primary field point of contact for practice administrators, billing/coding staff, and clinical staff on reimbursement matters related to Harrow buy-and-bill brands
• Provide non-promotional education on payer coverage policy, medical benefit billing/coding (HCPCS/CPT/J-codes, ICD-10, modifiers), prior authorization requirements, and claims submission best practices
• Support practices through the prior authorization and appeals process by educating staff on payer-specific requirements and documentation needs
• Educate practices on available support programs, including patient assistance, product replacement, and sample programs, and coordinate warm handoffs to the HUB as needed

Account Management & Business Reviews

• Build and maintain trusted relationships with key accounts within an assigned territory
• Conduct regular, structured business reviews with accounts to assess reimbursement performance, identify denial trends, and develop action plans to resolve barriers
• Proactively identify at-risk accounts (e.g., high denial rates, low utilization due to access friction) and develop targeted intervention plans
• Partner with Sales to align on account priorities and ensure a coordinated, compliant approach to customer support

Claims & Payer Analysis

• Conduct account-level claims analysis to identify denial patterns, coding errors, or payer-specific barriers, and translate findings into clear, actionable guidance for the practice
• Maintain current, deep knowledge of payer policies (commercial, Medicare, Medicare Advantage, Medicaid) relevant to assigned brands and territory
• Escalate systemic or complex payer issues to the National Sr. Director and Market Access leadership with supporting data and recommendations

Collaboration & Reporting

• Partner closely with the HUB and Patient Services team to ensure seamless coordination on benefit verification, PA/appeals support, and patient assistance
• Provide regular field intelligence and account-level insights to leadership to inform national strategy and payer engagement
• Maintain accurate, timely documentation of account activity, business reviews, and issue resolution in CRM/reporting systems
• Represent Harrow professionally and compliantly at all times, strictly adhering to all applicable laws, regulations, and company policies

• 7+ years of proven success in the healthcare-related field, reimbursement, brand management, and/or sales experience.
• Bachelor's degree preferred, or equivalent work experience.
• Buy-and-bill experience required.
• Minimum 2 years of Field Reimbursement experience required.
• Healthcare credentialing and/or certification preferred.
• Eye care experience preferred.
• Private equity experience preferred.
• HCPCS Level II (J-code) and Transitional Pass-Through reimbursement experience preferred.
• Experience with benefit verifications, prior authorizations, claim assistance, and appeals.
• Payer coverage experience with Medicare (MACs), Medicare Advantage, Commercial, and Medicaid plans.
• Experience in conducting claims analysis and conducting regular QBRs with accounts

• Remote

• Up to 80%