The Field Reimbursement Manager (FRM) will be responsible for providing education and support to healthcare providers and accounts to facilitate coverage and reimbursement of Tides products.
This role involves engaging with clinical and administrative staff to enhance understanding of insurance processes, prior authorization procedures, and coverage options.
The Field Reimbursement Manager will serve as a key resource in navigating complex reimbursement landscapes, ensuring timely and accurate access to our products for patients.
Additionally, they will play an instrumental role in onboarding new customers and sales agents by delivering comprehensive reimbursement training and education, fostering confidence and compliance.
This position combines clinical knowledge with strategic outreach, aiming to strengthen relationships with healthcare providers, support sales efforts, and optimize reimbursement processes.
The Field Reimbursement Manager will work closely with internal teams to ensure consistent messaging, compliance, and effective resolution of reimbursement challenges in a fast-paced, results-oriented environment.
Essential Functions of the Areas of Responsibility:
Perform the following in accordance with AATB, FDA, CMS, and Tides Medical stated policies and procedures while upholding Tides Medical's mission and corporate values. Responsibilities include but are not limited to:
Deliver training and educational sessions to new and existing customers on Tide’s Medical Benefits Verification Request procedures, billing practices, coding protocols, reimbursement for various places of service, and coverage policies
Serve as the primary reimbursement liaison for the Sales Team, bringing specialized knowledge in reimbursement processes to support their efforts
Deliver reimbursement training and resources to Tides Medical sales agents to enhance their understanding and support capabilities
Conduct in-person customer training sessions to reinforce reimbursement education and best practices
Perform ride-a longs with sales agents to observe and support effective reimbursement conversations and strategies
Assist customers in resolving denied claims and managing appeals to secure appropriate reimbursement
Work closely with a Claims Reimbursement Manager to investigate denied, partially denied, or underpaid claims, offering guidance on next steps and additional support required for resolution
Maintain regular communication with assigned customer accounts to identify and address reimbursement challenges proactively
Monitor payer policies and industry trends, and report relevant updates to internal teams
Act as a reimbursement expert, aligning reimbursement strategies with sales initiatives
Collaborate with the Tides Benefit Verification Team to facilitate the resolution of patient cases
Perform any other duties as assigned to support the team and organizational goals
Expectations:
Exhibit strong problem-solving skills, demonstrating independence and resourcefulness in resolving reimbursement issues, claim denials, and coverage challenges effectively
Maintain unwavering honesty and transparency in all communications and interactions with customers, payers, and internal teams
Show respect and professionalism towards colleagues, customers, and payers, refraining from discriminatory language or behavior to foster an inclusive and respectful work environment
Ensure strict confidentiality of sensitive information, including patient and provider data, payer details, and proprietary organizational information, adhering to privacy regulations and corporate policies.
Demonstrate excellent collaboration skills by working cohesively with team members, sales teams, provider accounts, and external partners to achieve common goals and maintain a positive, productive work environment
Qualifications:
Requirements:
Effective communication skills both verbally and in writing
Strong team player with a demonstrated history of collaboration in a team environment
Either a 2 or 4-year college degree or 2-5 years of relevant experience in Medical Reimbursement
Prior experience in a reimbursement-based call center environment, including knowledge of Medicare, Medicaid, and private-payer reimbursement methodologies.
Familiarity with the benefits investigation process (deductible, out-of-pocket, benefits exclusions, etc.) including prior authorizations and pre-determinations
Coding certification and/or training with experience in coding and billing in various settings such as physician office, hospitals, etc.
Thorough knowledge of coverage, coding and payment dynamics across all payer types
Understanding of medical billing & coding CPT, HCPCS, ICD-10, MUEs, NCCI Edits, etc.)
Strong computer skills, including proficiency in Microsoft Word, Excel, PowerPoint, and Outlook as well as experience with EMR or CRM systems and online resources
Proficient at delivering presentations to large and small groups
