Reimbursement Resume Sample

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Cierra Funk
56139 Flatley Island,  Houston, TX
+1 (555) 156 9377

Work Experience

Director, Field Reimbursement
10/2015 - PRESENT
San Francisco, CA
  • Current, unrestricted driver’s license in state of residence
  • Works to insure field alignment is optimized to meet customers’ needs
  • Partners with key internal and external personnel to target customers and drive appropriate and compliant influence as it relates to clients’ products and services
  • Communicating key messages of clinical, economic and social benefits of DNA Pap and HPV testing to payers, employer groups and women’s groups
  • Total business experience in diagnostics, medical device or pharmaceutical industry
  • Reimbursement experience, either in the public/private sectors or in the pharmaceutical/medical device industries
  • Strong interpersonal skills and ability to work effectively in teams across different functions and countries
Medicaid Reimbursement
01/2013 - 09/2015
Chicago, IL
  • Works with manager to support the client needs and contract requirement and identifies client issues
  • Compiles and provides a wide range of routine reports related to program management and clients
  • Work closely with Medical College of Wisconsin and Children’s Specialty Group. Monitors the appropriateness of coding, documentation and charge capture process. Assists with the resolution of problems with respect to coding and documentation
  • Prepares the department budget and manages use of resources within budget targets
  • Responsible for hiring, retaining, evaluating, mentoring and firing managers and staff within the department
  • Responsible for managing all financial and compliance risk associated with the reimbursement function (for acute and professional services), notifying senior leadership of identified risks and tracking and monitoring progress of risk management plans
  • Directs the preparation of RHM net revenue calculations and reviews with the Vice Presidents of Finance prior to financial statement due date. Directs the preparation of the budgeted net revenue calculation for the RHMs
  • Manage the overall balance sheet position related to third party contractuals and related reserves. Provide updates to Senior Leadership to avoid any surprises
  • Develops strategic reimbursement planning and analysis for short and long-term operating plans and capital projects (for acute and professional activities)
Field Reimbursement Mgr-dallas
05/2010 - 12/2012
Los Angeles, CA
  • Rounded financial experience including AR collection & cash allocation
  • Convincing communication skills
  • Maintain positive relationships with Finance/ Operation/ Call Center/ Service Provider
  • Good understanding of relevant tools and systems (SAP)
  • Skilled in MS Office, file-sharing systems (we use Box) and other Web-based systems related with Tax Invoice generation
  • Technical aptitude to solve basic desktop problems. Resourceful in searching Web for IT solutions
  • Analytical skills, communication skills, learning and adaptability, leadership skills (both leading team and playing leadership role in specialty franchise), influencing skills (working across internal stakeholders in Ridgefield and Ingelheim, as well as external stakeholders in the specialty and payer community


Argosy University - Orange County Campus
2005 - 2009
Bachelor's Degree in Business

Professional Skills

  • Proven presentation/public speaking skills and experience
  • Strong PC skills and working knowledge of participant recordkeeping software applications
  • Strong planning and organization skills, attention to detail, execution, and follow-through
  • Proven ability to effectively handle multiple priorities in a fast-paced, changing environment
  • Maintain an outstanding level of territory planning, organization, and administrative skills
  • Demonstrated work experience applying PC-based analytic tools to provide support to a health insurance or clinical process is required. (Excel, Word)
  • Strong technical medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy

How to write Reimbursement Resume

Reimbursement role is responsible for organization, insurance, design, medical, health, analytical, finance, credit, training, mac.
To write great resume for reimbursement job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Reimbursement Resume

The section contact information is important in your reimbursement resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Reimbursement Resume

The section work experience is an essential part of your reimbursement resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous reimbursement responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular reimbursement position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Reimbursement resume experience can include:

  • Intermediate to advanced Excel skills including use of v-look ups & pivot tables
  • Demonstrate understanding of payor policies, such as Medicare coding, coverage, and payment
  • Facility and experience interpreting clinical and health economic/outcomes research data
  • Related reimbursement strategy and/or revenue cycle management experience in diagnostic laboratory or healthcare related field
  • Researching, analyzing and presenting compelling insights on the environment, reimbursement statistics and other market information
  • Assist managing complicated, interconnected projects across teams (including managing meetings, action items and timelines)

Education on a Reimbursement Resume

Make sure to make education a priority on your reimbursement resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your reimbursement experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Reimbursement Resume

When listing skills on your reimbursement resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical reimbursement skills:

  • Strong analytic skills necessary
  • Excellent interpersonal skills - client service orientation
  • Solid written communication skills to enable incumbent to prepare accurate and detailed work papers and reports
  • Effective time management and organization skills and the ability to manage multiple projects in a fast paced environment
  • Healthcare industry experience within managed care, commercial insurance or facility billing (hospital, Skilled Nursing Facilities -SNFs, home health, etc.)
  • Customer service experience, 2+ years medical or insurance industry experience

List of Typical Experience For a Reimbursement Resume


Experience For Director, Field Reimbursement Resume

  • Broad functional experiences in the US specialty market (particularly sales/sales management and/or marketing, pricing/reimbursement and/or account management and/or managed markets, distribution/specialty pharmacy and/or policy/government relations and/or patient advocacy/professional relations)
  • Effectively leads, coaches, and counsels team members as necessary
  • Accurate completion, and timely filing, of all third party cost reports, including Medicare, Medicaid and CHAMPUS reports
  • Ensure claims are written off at designated number of days according to payer and that proper tracking is in place for bad debt recovery
  • Analyze denials on a monthly basis and implement processes to decrease denials by focusing on top denial reasons
  • Coordinates with others, including personnel in centralized departments as well as local practices to exchange information and coordinate efforts
  • Organize unit personnel and establish efficient workflow and procedures to ensure cash collection and billing goals are met consistently

Experience For Reimbursement Director Resume

  • Maintain up to date knowledge and documentation of all contracts and billing guidelines
  • Develop and implement reporting tools to manage trends, direct staff and communicate results to the director and administration
  • Plays a diverse and complex role
  • Subject matter expert on understanding complex economic implications of reimbursement strategies on wide and varied stakeholders (patient co-pays/out-of-pocket, provider economics, network implications and specialty pharmacy impact, etc.)
  • Works collaboratively with a wide range of internal and external stakeholders to develop, recommend, gain approval and implement of access, reimbursement, and patient support strategies and tactics

Experience For Executive Director, Access & Reimbursement Resume

  • Plays leadership role in shaping direction and culture of specialty franchise as well as the primary care franchise (where appropriate) at BI
  • Summarize Medicare rules and draft public comments, with supervision, for CMS’ proposed rules
  • Interpret complex trends and concepts into concise and digestible communications
  • Present reimbursement information in a way that is relevant and tangible to multiple different audiences
  • Lead Otsuka’s U.S. efforts to analyze and understand Medicare/Medicaid and private payer reimbursement methodologies
  • Create and deliver analyses for Otsuka federal and state lobbyists, business leaders, and trade associations that increase access to the organization’s products and therapies
  • Function as liaison to Central Business Office and communicate regularly with them working together to improve division days in A/R, collections, decreased denials and other dashboard indicators
  • Work with other staff such as receptionists and others in the practices that have revenue cycle responsibilities, in coordination with their managers, to provide training, auditing of work, process improvement, etc

Experience For Director, Reimbursement & Policy Resume

  • Oversees the timely and accurate data entry of charges
  • Assesses self pay policies, improve them as needed; implement reception audits and other processes to improve self pay front end and back end collections
  • Assesses pre-authorization policies and processes and change as needed to decrease denials
  • Analyze fee schedules and modify as needed to appropriate reimbursement
  • Analyze enrollment processes and work with enrollment department to improve timeliness of completed enrollment and to minimize claims to hold and enrollment related denials

Experience For Medicaid Reimbursement Resume

  • Regularly review AR data and develops strategies to improve revenue. Use A/R standards (dashboards) where already established or establish those that do not exist; monitor and report on them monthly with action plans for improvement where needed
  • Assess current E&M coding analysis reports; utilize if adequate; if not, enhance it or create E&M bell curve coding analysis tool; determine appropriate way to ensure physicians are documenting and coding properly. Work with coding and compliance departments as needed and always ensure appropriate compliance
  • Ensures that correct coding and compliance guidelines are being adhered to
  • Report issues to the Business Office Director and compliance hotline
  • Prepares the bi-annual Occupational Mix Survey utilized by CMS in the calculation of the Wage index; compares published data (PUF’s) to original submission data to ensure accuracy

Experience For Reimbursement, Access, & Value Director Resume

  • Reviews physician attestation statements for all compensated physicians. Compiles summary of payments and hours for Medicare reporting. Determines Part A and Part B splits
  • Works directly with Medicare Administrative Contractor (MAC) auditors during the audits of Medicare cost reports and Wage Index submissions
  • Interfaces with outside consultants utilized by the department to preparation of reports for Medicare Bad Debts, Disproportionate Share (DSH) and LIP calculation support
  • Analyzes Medicare and Medicaid regulations, quantifies impact of changes and reports to VP Finance
  • Prepares annual profit and loss statement for all Graduate Medical Education programs; presents and discusses results with Medical Education Program Directors (physicians)
  • Prepares annual accounts receivable summaries and analysis during the annual financial audit. Works closely with external financial auditors during accounts receivable validation testing and valuation

Experience For Manager of Reimbursement Resume

  • Prepares Concentration of Credit footnote and supporting documentation for the annual audit report
  • Prepares detailed analysis of net patient revenues and accounts receivable during the monthly financial reporting process. Prepares net revenue variance analysis and presents to VP’s and CFO during statement review meetings
  • Lead assigned Provider Reimbursement analyst team in establishing process direction, providing internal customer satisfaction and provider satisfaction, tracking progress, making decisions, and resolving conflicts
  • Lead assigned Provider Reimbursement analyst team in updating and creating fee schedules, code pricing, and reimbursement approaches
  • Provide strategic guidance on provider reimbursement for contracting, claims payment, and provider satisfaction in alignment with Corporate goals

Experience For Reimbursement Senior Manager Resume

  • Maintain Reimbursement policies, documentation and billing guidelines related to areas of responsibility
  • Collaborate with Access Marketing, RAV lead and brand to maintain/develop patient support programs for in-line and launch brands
  • Collaborate with Access Marketing to develop brand-specific support program messages and tools for the BCBU sales teams
  • Actively participate and oversee team involvement in cross-functional projects
  • Oversees internal and external audits for fee schedule accuracy and payment accuracy
  • Development and execution of RAV strategy for the CV Portfolio
  • Function as the Payer lead of the Forecast, Brand Plan, Budget and Strategy and Execution for the Brand

Experience For Regional Director of Reimbursement Resume

  • Conduct periodic brand-specific RAV team meetings (usually monthly) to communicate strategy and to drive alignment and execution
  • Collaborate with Value Marketing team to create brand specific value strategy, messaging, tools for Organized Customer Team (OCT) and data generation plan in alignment with brand strategy
  • For sales force and OCT new hires, provides RAV-related training
  • Coordinate and prepare reimbursement related consulting projects
  • Maintain a working knowledge of rules and regulations of the Medicare and Minnesota Medicaid programs

Experience For Manager Reimbursement Resume

  • Data analytics and basic financial modelling of exploratory business scenarios
  • Analyze internal processes to recommend and implement streamlining process improvements
  • Track OCT coverage/POA goals and support dashboard activities
  • For sales teams and OCT, triage RAV related questions and issues and ensures that items are addressed
  • Develop familiarity with managed care contracts and methods of payment by managed care organizations
  • Research various topics as necessary for clients or CliftonLarsonAllen personnel related to Medicare and Medicaid regulations

List of Typical Skills For a Reimbursement Resume


Skills For Director, Field Reimbursement Resume

  • Five (3-4) years of experience in accounting in order to demonstrate technical and professional skills in cost accounting and systems analysis
  • The analytical skills necessary to design and evaluate the assigned task and to probe the basis for underlying assumptions
  • Prior supervisory experience is required
  • Proven teamwork skill set
  • Working knowledge of a personal computer including significant experience with Microsoft Excel/Access as well as Hyperion
  • Direct assigned staff in identifying and prioritizing required tasks
  • Proven learning agility in a highly dynamic environment

Skills For Reimbursement Director Resume

  • Proven strategic thinking and ability to take projects from inception to execution
  • Previous work experience in consulting, in a multi-hospital system
  • The ability to deliver effective presentations
  • Self-starter with strong initiative in both team-based and individual environments
  • Four to five years of financial analysis experience in a hospital/healthcare environment is required

Skills For Executive Director, Access & Reimbursement Resume

  • Two to Four years’ experience in the Respiratory Biologics therapeutic area
  • Five years of provider reimbursement experience, required
  • Experience with all Fee schedules (APG, APC, APR-DRG, OMH, etc.), required
  • Managed Care / Health Care Experience, required
  • Experience with revenue
  • Experience with infusible buy & bill products in Immunology and/or gastroenterology
  • Experience in a reimbursement related function
  • Experience with health insurance processes like claims adjudication, medical necessity documentation review, utilization management and care management

Skills For Director, Reimbursement & Policy Resume

  • Complex reimbursement experience
  • Experience with computer applications to include spreadsheet, database, and processing as well as knowledge of billing and accounting systems
  • Demonstrate knowledge of billing requirements, government regulations, and accounts receivables principals
  • Skilled in Microsoft Office or comparable computer software programs (e.g. word processing, spreadsheets and databases)
  • Strong ability to work independently as well as lead teams; multi-task in a fast paced environment and project management to meet goals and deadlines
  • Provides the most effective communication to health plans to ensure maximum level of reimbursement approval

Skills For Medicaid Reimbursement Resume

  • Understanding of finance and accounting concepts/principles
  • Growing company looking for positive attitude
  • Working with appeals & denials for both in/out of network insurance claims
  • Calling into insurance companies to get correct claim information
  • Utilizing major EMR systems and Excel
  • Collaborates with Segment, Value Marketing and training to develop OCT semester plan of action, semester meeting content/training and reimbursement goals
  • Data analytics (including a basic understanding of financial modelling)
  • Project management (including managing complex deliverables across teams under demanding timelines)
  • Over a team of 6 - including training and producing

Skills For Reimbursement, Access, & Value Director Resume

  • Provides and oversees reimbursement training for financial, billing and accounting staff
  • Innovative strategic thinking with a passion for challenging the status quo
  • Audit DRG calculator by comparing computed rates in the billing system to rates paid by Medicare and Medicaid
  • Assist the Administrative Director of Reimbursement in preparing the Hospitals’ strategic planning module
  • Develop access plan of action (POA), and collaborate with training to train new hires and to provide training and direction at semester meetings
  • Collaborate with Segment Marketing to develop payer clinical messaging and tools for OCT

Skills For Manager of Reimbursement Resume

  • Prepares, analyzes and maintains cost data as required for regulatory reporting and new program submissions on an ongoing basis and as requested
  • Assists in managed care budget planning and goal setting for gross and net revenues
  • Secure appropriate coverage, coding and payment parameters for Sandoz’s products
  • Assist staff in meeting deadlines and monitor the department’s quality plan
  • Complete analysis related to third party reimbursement area related to the compilation of the Hospital’s annual operating budget
  • 40 claims a day- however, they are wanting quality over quantity
  • Responsible for the accurate reporting of PA Medicaid Modernization program Provider taxes and revenues
  • Expert knowledge of current reimbursement and reporting rules and regulations

Skills For Reimbursement Senior Manager Resume

  • Understand national initiatives affecting reimbursement of Durable Medical Equipment and Supplies, physicians, tele-health and other care settings
  • Monitors receivables and collections data as available to provide detailed analysis of accounts receivable to physician billing functions
  • Prepares financial feasibility studies, operational systems; review/evaluate studies, and administrative/planning studies as assigned
  • Maintains current knowledge of Federal and State regulations pertaining to program benefits and reimbursement
  • Establish procedures so that appropriate submission, billing and payment cycles of patient accounts can be maintained
  • Proficiency with Microsoft Office (particularly Excel, Outlook, Powerpoint and SharePoint)
  • Interest in the inner-workings of the Canadian drug reimbursement environment
  • Manage territory and all assigned accounts within set budget

Skills For Regional Director of Reimbursement Resume

  • Capability to monitor drug coverage policies for multiple payers. Review case outcomes to
  • Provides expert guidance on all facets of access services to ensure that all aspects are aligned to protect both the patient’s and Valeant’s interests
  • Be able to build professional relationships while navigating sensitive conversations related to access, cost and reimbursement in a manner that supports the vision of Takeda’s partnership and commitment to the specialty community
  • Lead account training with key stakeholders on the use of Takeda’s reimbursement and support services, including but not limited to HUB services
  • Excellent oral and written communication skills and the ability to communicate complex issues in an organized format for clear understanding and analysis. Proficiency in analyzing and documenting performance through spreadsheets, graphs, flowcharts, etc

Skills For Manager Reimbursement Resume

  • Demonstrated proficiency in the utilization of computer software programs such as Business Objects, Peoplesoft and Microsoft office products
  • Masters in Business Administration, Public Administration or Health Administration or closely related field
  • Five years of management/supervisory experience in a Managed Care Organization that includes financial analysis, provider rate setting; financial statement preparation or review; or auditing experience and supervisory responsibilities
  • Manages the healthcare organization's reimbursement activities and initiatives, to ensure timely and accurate finical reporting
  • Identifies and implements strategies, policies, procedures and programs for all aspects of reimbursement management practices
  • Monitors and communicates federal and state regulatory proposals and changes regarding healthcare reimbursement and providing effective solutions to address reimbursement issues
  • Manages the productivity and performance of reimbursement staff members

List of Typical Responsibilities For a Reimbursement Resume


Responsibilities For Director, Field Reimbursement Resume

  • Increasing levels of supervisory or leadership experience
  • Experience in commercial physician reimbursement policy and claims editing adjudication
  • Communicate spend experience and explain anomalies to management
  • Advanced knowledge of hospital accounting and Medicare cost accounting fundamentals
  • Research related to Medicare and Medicaid reimbursement and developing a reimbursement library

Responsibilities For Reimbursement Director Resume

  • Knowledge of billing requirements, government regulations, and accounts receivables principals
  • Responsible for the development of services to provide to CliftonLarsonAllen clients and potential clients to positively impact revenue
  • Become actively involved in practice management; i.e. participating in professional organizations and associations which develop/build relationships with clients, potential customers, and industry leaders, writing/developing proposals, etc
  • Management of team sites and file structures
  • Work with the Sales and Reimbursement leadership teams within REGN and Genzyme
  • Meets cash collection targets
  • Audit and monitor payer reimbursement activity to ensure contract compliance; convey information to patients, physicians, and employees
  • Coordinate with clinical management staff to resolve conflicts and seek their intervention in patient care matters

Responsibilities For Executive Director, Access & Reimbursement Resume

  • Establish business relationships with internal and external payer sources to ensure payer’s compliance to contract terms and collections of amounts due
  • Establish and manage strategic relationships with outside collection agencies based on company needs and specific payer issues
  • Review write-offs and approve for completion
  • Project collection of accounts receivable, and report accounts receivable status to administration. Review all refund requests for accuracy and forward to Accounts Payable for processing
  • Knowledge of medical terminology and general patient care delivery in Home Health and Hospice

Responsibilities For Director, Reimbursement & Policy Resume

  • Direct the establishment and maintenance of approximately two dozen fee schedules; determination of reimbursement rates; calculation of potential fiscal impacts; implementation and maintenance of rates
  • Direct the design, development, implementation and evaluation of new reimbursement methodologies; address issues surrounding reimbursement rates and methodologies; engage with provider community
  • Research techniques for collecting, analyzing, interpreting and communicating results to others
  • Oversee supplemental payment calculations, payment approval and processing
  • Oversee the provider incentive programs including the Electronic Health Records (EHR) Program, the Targeted Investments (TI) Program, the Access to Professional Services Initiative (APSI) and various Differential Adjusted Payment initiatives; including provider eligibility determinations, payment approvals and issue resolution
  • Demonstrated knowledge of the Electronic Health Records (EHR) program
  • Direct computation of assessment fees paid by hospitals and nursing facilities, track payment/non-payment of assessments, ensure proper follow-up action
  • Draft, develop and monitor State Plan amendments, Arizona Revised Statute amendments, Arizona Administrative Code revisions and agency policy
  • Demonstrated knowledge in claims and encounter payment data and ability to analyze payment data and prepare fiscal impact analyses within the regulatory guidelines for presentation to Executive Management, Legislative staff, consultants, other AHCCCS staff, etc

Responsibilities For Medicaid Reimbursement Resume

  • Demonstrated knowledge of medical fee-for-service rate setting for a health care insurer, preferably with State Medicaid program(s); and developing, implementing and evaluating payment systems
  • The field reimbursement position conducts training and education for new accounts and existing accounts identified by the UC and the hotline. Education consists of insurance benefit completion and process, billing and coding of BSC products and utilizes additional resources available through the Health Economics & Market Access team
  • After initial education of the account, regular follow-up with the account is conducted either via phone or in person to ensure proper coding and claims submission of BSC products, identify any reimbursement issues and work with the account to resolve until appropriate payment is received
  • Communicate procedures for physician office, ambulatory surgery center, and/or outpatient facility billers to implement process to ensure maximum efficiency and collection of their accounts receivable, including coding procedures and processes for denial and low payment appeals
  • Build relationships with provider staff and provide exceptional customer service
  • Works as a liaison with the account, sales and reimbursement hotline to provide information required to complete timely benefit verifications
  • Completes daily reports as assigned

Responsibilities For Reimbursement, Access, & Value Director Resume

  • Follows HIPAA policies and procedures to ensure protected health information is secure and not accessible to employees not authorized to view the information
  • Adheres to the organization’s appeal strategy and manages the on-going tactical application of the appeal strategy to ensure a successful reversal rate in conjunction with the Reimbursement Hotline
  • Reports reimbursement trends and global concerns to management to ensure corrective actions and mitigation of future occurrences
  • Troubleshoots national and local payer reimbursement and accounts receivable issues
  • Analyzes operation of systems, prepares recommendations and documentations to create and update fiscal service and other related policies and procedures with respect to operating systems
  • Prepares Return on Investment (ROI), Net Present Value (NPV) and Product Line Analysis for designated hospital and related entities
  • Supervises, orients, trains, assigns work/projects to and evaluates outcomes of financial analyst
  • Maintains required records, reports and files
  • Designs a set of AVEGA ADS managed care reports (through the use of Crystal report writer) for monthly distribution to the Regional and Hospital CFO’s as well as the VP of Managed Care

Responsibilities For Manager of Reimbursement Resume

  • Enhances professional growth and development through in-service meetings, educational programs, seminars, conferences, workshops in order to keep abreast of trends and changes in the field
  • Assists in the annual chargemaster update process and subsequent payer impact analyses
  • Performs, analyzes and completes ad-hoc reports as requested
  • Familiarity with the healthcare environment and health systems
  • The interpersonal skills necessary to work effectively with hospital administration, division directors, department managers, other personnel and outside professionals
  • The communications skills necessary to document clearly and concisely the analyses in writing and to communicate ideas, conclusions, etc., both written and orally
  • Provides daily oversight and guidance to professionals in the Fee/Rate Schedule Maintenance and Provider Reimbursement Operations teams
  • Responsible for all aspects of fee schedule implementation including: monitoring, preparation, quality control, and impact modeling of all changes to Federal and State reimbursement methodologies as well as provider contract updates

Responsibilities For Reimbursement Senior Manager Resume

  • Ensures that all financial impacts on fee schedule changes are performed accurately and within established service level agreement days
  • Ensures that all published fee/rate schedules and updates are accurately loaded within established service line agreement days
  • Ensures all provider and other disbursements are processed accurately and timely on a weekly basis
  • Collect, analyze, and summarize information and spend trends in order to prepare standard and ad hoc financial reports
  • Establishes and maintains policies and procedures for all tasks in the department
  • Establishes and maintains relationships with business partners to ensure all processes owned by Finance are completed on time
  • Represent department and Finance in cross functional team meetings to provide provider reimbursement guidance
  • Ensure all policies, reports, schedules, registers and logs required of the department are properly maintained and issued as required

Responsibilities For Regional Director of Reimbursement Resume

  • Implement the financial policies and procedures that relate to receivable management to insure established collection targets are met and receivables are maintained at an acceptable level
  • Prepare reports and proposals, and recommends actions, including training programs where appropriate for internal and external customers
  • Oversight of productivity monitoring and receivable operations in order to improve internal controls and productivity levels
  • Ultimate responsibility for the entire billing, collections and insurance verification operation, ensuring the automated and/or manual accounts receivable records meet established standards
  • Strong automated billing and health care accounts receivable management
  • In health care reimbursement required
  • Define and implement an integrated payer strategy to maximize access and reimbursement for Spectrum portfolio
  • Collaborate with cross-functional team to develop and operationalize payer strategies (segmentation, pricing, contracting, value proposition and account management). Requires a deep understanding of the current and future trends of the US Market Access landscape

Responsibilities For Manager Reimbursement Resume

  • Establish, maintain, and lead reimbursement support programs, patient assistance programs, and copay/coinsurance assistance programs for patients for Spectrum portfolio. Responsible for all vendor management and contracting
  • Work to establish and maintain, as needed, appropriate healthcare coding for Spectrum products within standard HIPAA transaction code sets. Experience with HCPCS codes (J-codes, C-Codes, Q-codes, A-codes), CPT codes, ICD-10 codes, NDCs essential
  • Lead the pull-through of payer and channel marketing initiatives to drive access and use, including initiatives which compliantly educate healthcare providers about reimbursement landscape for Spectrum products
  • Develop and maintain compliant training materials to educate Spectrum staff about coverage, coding, and payment landscape for Spectrum portfolio, as well as approved resources to address such issues
  • Develop and rollout provider-facing Access and Reimbursement materials and accompanying Field Direction Bulletins to compliantly educate healthcare providers about coverage, coding and payment issues to support patient access to care for Spectrum portfolio for FDA-approved indications
  • Expert knowledge of CMS, Medicare Part B drugs and biologicals policy, Medicare Advantage plans, Medicare Part D and CGDP, private payer sectors, state Medicaid programs, VA FSS/healthcare system, PBMs, Specialty Pharmacy
  • Experience with healthcare coding systems and processes, including submitting HCPCS applications, and understanding ICD-9 to ICD-10 conversion
  • Experience in recruiting and building teams, managing people, desired
  • Work with pricing team to coordinate WAC and new product information submissions to third party pricing services

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