Remote Prior Authorization Nurse Jobs in Decatur, GA

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The Field Reimbursement Manager (FRM) is responsible for managing an assigned territory focused on supporting Reimbursement and Patient services by providing assistance with patient reimbursement challenges for a specific drug (including Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client-facing and customer-facing and requires the ability to build relationships with physician offices as well as manufacturer representatives to effectively deliver services based on customer specific preferences. The Field Reimbursement Manager works independently in a fast paced, highly visible environment as well as collaboratively with the internal program hub support services to ensure all customer needs are met. FRM will frequently interact via telephone with providers and internal staff to arrange site visits, Manufacturer trainings, and educational training venues. Must have a solid working knowledge of Medicare and Commercial insurance plans and benefit structures in order to relay detailed benefit information and maximize the customer experience. Position will require travel, project management and/or account coordination based on client expectation.

Key Responsibilities:

• Provide on-site and on-demand education (including Lunch and Learns or Dinner presentations) for the office staff in regard to Reimbursement challenges and support services that are available. Office interaction will include education and reimbursement support.  On-site/virtual interactions will average 15 per week. These activities are recorded in FRM CRM daily with reporting to manager weekly.

• Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams.  Monthly activity reporting captures educational topics at FRM level reportable to client based on client expectation.  This trended data is also reported quarterly to client.

• Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs. FRM will collaborate with case manager on average of 4/month and ad hoc as needed for escalations. These interactions are tracked in FRM CRM and hub system.

• Responsible for setting up appointments and completing outbound calls to targeted offices. Assist in completing backlog casework. Additional day-to-day in-office work. Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.  All FRM interactions/activities are tracked in FRM CRM which are reportable to management and client.

• Monitor program performance for physicians and manufacturer representatives in accordance with expectations. Territory performance will be monitored via FRM CRM dashboard daily.  Trending results will be identified through quarterly reporting.  Additionally, clients have the option to survey customers on program performance.

• Research and compile provider / manufacturer representative specific information for reimbursement database. (Includes account profiles) FRM will create a facility database on each new provider in FRM CRM.  All interactions/activities are built utilizing this database. 

Minimum Job Qualifications –

• 4-year degree in related field or equivalent experience

• 4+ years of healthcare related reimbursement experience

Business Experience –

• Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.

• Experience supporting oncology products preferred

• Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.

• Must have Medicare and commercial insurance coverage experience.

• Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis.

• Proven presentation skills and experience

• Proven ability to effectively handle multiple priorities and excellent organizational skills

• Strong Computer literacy to include PowerPoint and Web Meeting experience    

Specialized Knowledge/Skills –

• Previous field experience, a plus

• Previous experience with specialty pharmacy a plus

• Account management experience, a plus

• Excellent Interpersonal skills.

• Excellent written and oral communication skills

• Problem solving and decision-making skills

Travel Requirements –

Looking for candidates in the following: Atlanta, GA, Birmingham, AL, Memphis, TN, New Orleans, LA, Tulsa, OK.

Must reside in territory.  

Must be able to travel 80% (4 days a week) via automobile or plane. 

Must have a valid driver's license with a clean driving record/ MVR

Physical Requirements (Lifting, standing, etc.) –

Possible long periods of sitting and/or keyboard work. General office demands.

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here.

Our Base Pay Range for this position

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