How To Become a Field Reimbursement Manager

Helping bridge the gaps between patients, insurance companies, and healthcare organizations is a tricky role. Field reimbursement managers make sure barriers to healthcare access are removed.

The services performed by healthcare providers are tied directly to health insurance reimbursement and coverage. To help understand the link between service and insurance coverage, many healthcare organizations hire field reimbursement managers (FRMs) to help all patient care stakeholders understand the reimbursement process.

Steps for Becoming a Field Reimbursement Manager

Becoming a field reimbursement manager is a fairly specialized role. The job revolves around figuring out how to collaborate with healthcare providers, insurance companies, and patients to ensure no reimbursement issues can impact patient care.

To become an FRM, several steps need to be taken regarding education and earning experience.

1. Find Out Which Major Is Best for You

Although schools don't offer degrees in field resource management, several majors will be better suited for an FRM career than others. To evaluate which majors are best for potential field reimbursement managers, you should look at the skills needed for the role.

FRMs need to understand the financial side of insurance coverage, but they also need to understand the human component from both the patient and caregiver side. Lastly, FRMs must understand the health information beyond the knowledge level of a layperson.

Some ideal majors to prepare a graduate for a job in field reimbursement management include:

2. Find the Right School for Your Major

Once you've selected the major you want to pursue to become a field reimbursement manager, the next step will be to choose a school that offers that major.

Because multiple degrees can be used to start a career as a field reimbursement manager, there are many school options you can pursue, including:

3. Obtain a Bachelor's Degree

Once you've selected your major and a college, it's time to apply for enrollment. Because an FRM requires a diverse skillset, you might want to consider selecting a major and a minor to help provide all the skills you need.

4. Earn a Field Reimbursement Certification

Even with a degree, working as a field reimbursement manager will require additional certification. To begin work as a field reimbursement manager, start with the Prior Authorization Certified Specialist (PACS) certification. This certification is issued by the National Board of Prior Authorization Specialists (NBPAS) and certifies that FRMs are experts in topics like reimbursement, patient access, and medical billing.

There are further certifications that are optional but can be very beneficial to your future career. One of the main additional certifications that you can pursue is the Board Certified Biologics and Biosimilars Specialist Program. This certification works with the growing field of biologics and how they are covered by different insurance plans and Medicare.

5. Gain Experience Working in the Healthcare Field

As valuable as formal education is, nothing compares to the training that comes with years of experience. Working as an FRM will help you develop skills in patient support and problem-solving that school can't.

6. Consider an Advanced Degree

Although many field reimbursement manager positions only require a bachelor's degree in a related field, if you want to prepare yourself for management roles or you just want a deeper understanding of the topics related to field reimbursement management, pursuing a master's or doctoral level degree might be the next career step.

What Is a Field Reimbursement Manager?

As health insurance plans from private companies and public plans like Medicare change, healthcare organizations need people who can understand the submission process around insurance claims and help settle reimbursement issues as they arise. At most larger organizations, this role has the job title of field reimbursement manager.

An FRM works outside of some of the other teams within an organization, but their work is directly impacted by these other teams.

Some of the teams that a field reimbursement manager works with daily include:

sales team
accounting
patient care teams
the healthcare organization's office staff

Responsibilities of a Field Reimbursement Manager

Ultimately, the main responsibilities of an FRM are to provide patient support and help them have access to the care they need and deserve. This comes by working directly with the patient to understand their insurance coverage and see which therapies are covered.

Skills Required of a Field Reimbursement Manager

To successfully complete these responsibilities, FRMs need certain skills that come from a combination of coursework, studying, and experience.

Some of the skills required to be a field reimbursement manager include:

understanding Excel
knowledge of various insurance plans and government-payer plans, like Medicare
human resources skills to provide support services for the sales team and care providers

Benefits of Being a Field Reimbursement Manager

Being an FRM can have many benefits. One of the main benefits is that the role is in demand at a variety of locations. As insurance companies continue to change coverage and new therapies are created, like biologics, it will only become more important to have FRMs. This demand also translates to high pay rates and growth opportunities.

Another benefit of becoming a field reimbursement manager is the knowledge that your help could be what makes the difference between a patient getting the care they need or not.

FAQs About Field Reimbursement Managers

Not many people know about field reimbursement management as a career path, so it's common for questions to arise before starting higher education for this job.

Do Field Reimbursement Managers Ever Work with Patients Directly?

Field reimbursement managers work on behalf of patients, but they don't have the same kind of frontline roles that nurses and doctors do. Much of the patient assistance that an FRM offers is behind-the-scenes work between the healthcare organization and insurance companies, as opposed to patient care. This role does sometimes involve communication with patients, but mostly via phone or email as opposed to face-to-face meetings.

How Do You Maintain a Professional Certification as a Field Reimbursement Manager?

Because field reimbursement management requires certification, it's important to know that your certification can expire if you don't maintain it. Luckily, maintaining an FRM certification is fairly easy. Whichever certification body you received your certification from will have approved classes that you need to take yearly to maintain your certification status. For most certifications, there will be a requirement of 10 minimum continuing education classes.

What Other Career Paths Are Available for Field Reimbursement Managers?

Field reimbursement managers have multiple skills that prepare them for their careers, but also for many other career paths as well.

Based on the skills they've developed, FRMs can also have job titles like:

account management
human resources management
healthcare administration