Field Reimbursement Manager managing patient access in defined geographic region for a biotechnology company. Supporting products and ensuring understanding of reimbursement processes and patient support programs.
Responsibilities
Manage defined accounts within a specified geographic region for Patient Access and Reimbursement
Support products by executing the collaborative territory strategic plan
Ensure an understanding of the reimbursement process, field reimbursement services, and patient support programs
Work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI)
Act as an extension of the HUB, providing live one-on-one coverage support
Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms
Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges
Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access
Coordinate access/reimbursement issues with relevant partners, including the HUB
Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)
Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders
Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution
Educate offices using approved materials
Review patient insurance benefit options and alternate funding/financial assistance programs
Collaborate with other departments to resolve reimbursement issues
Requirements
Doctorate degree OR Master’s degree and 3 years of customer service and/or leadership experience OR Bachelor’s degree and 5 years of customer service and/or leadership experience OR Associate’s degree and 10 years of customer service and/or leadership experience OR High school diploma / GED and 12 years of customer service and/or leadership experience
Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge
Proven presentation and facilitation skills
Strong written and oral communication skills
Organizational skills and project management experience, including the ability to manage multiple projects
Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers
Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types
Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region
Live in the geography or less than 10 miles from the geography border
Benefits
A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions
group medical, dental and vision coverage
life and disability insurance
flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans
Flexible work models, including remote and hybrid work arrangements, where possible
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