Access & Reimbursement Manager
Lockwood® · New York, NY · 4 wk ago
FinanceFull-time
We need to output HTML fragment with headings for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes: About Stratis Group (company description) and Summary (role description). Could map to "About the role". Responsibilities: many bullet points. Requirements: "Desired Job Requirements" list. Qualifications maybe overlapping; but we can treat "Desired Job Requirements" as Requirements. Qualifications maybe not separate; we could combine or omit if no distinct content. Skills: maybe list of abilities like solution oriented mindset, strong business acumen, analytic capabilities, etc. Benefits, Pay, Schedule: not provided. So we should not include those sections.
We need to use
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes: About Stratis Group (company description) and Summary (role description). Could map to "About the role". Responsibilities: many bullet points. Requirements: "Desired Job Requirements" list. Qualifications maybe overlapping; but we can treat "Desired Job Requirements" as Requirements. Qualifications maybe not separate; we could combine or omit if no distinct content. Skills: maybe list of abilities like solution oriented mindset, strong business acumen, analytic capabilities, etc. Benefits, Pay, Schedule: not provided. So we should not include those sections.
We need to use for each section heading. Use - for any list of duties/requirements/benefits. Use
for prose.
We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc. The posting includes some boilerplate like "About Stratis Group:" and "Summary:" but those are substantive. We'll keep.
We need to format: maybe first
About the role
then a containing the company description and summary combined? Or separate paragraphs. The instruction: use
for prose. So we can put the descriptive text in
. Then responsibilities as
Responsibilities
then - each bullet. Requirements as
Requirements
then - . Skills as
Skills
then - . Ensure we don't repeat job title.
We need to extract bullet points from responsibilities and desired job requirements.
Let's parse responsibilities from the text:
From "Summary:" paragraph: It includes many sentences describing role. Might be considered responsibilities but we can treat as part of About the role. However we need to separate responsibilities list.
The responsibilities list appears after "Additional Responsibilities Include". Let's extract:
- Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
- Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
- Provide in-person customer visits.
- Participate in client meetings as appropriate.
- Participate in regularly scheduled internal team and cross-functional meetings and calls.
- Input call activity into customer CRM, as appropriate.
- Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers.
- Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner.
- Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
- Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
- Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
- Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.
Also earlier responsibilities: "The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources." etc. But we can incorporate those into responsibilities list as well.
Better to gather all responsibility statements:
From summary paragraph:
- The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources.
- The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform.
- Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape.
- The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE).
- As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role.
- In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients.
- The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.
Then the "Additional Responsibilities Include" list above.
We should combine all into one responsibilities list, preserving each distinct point.
Now Desired Job Requirements:
- 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
- 4-year degree in related field or equivalent experience
- Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
- The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
- Solution oriented mindset, strong business acumen, & strong analytic capabilities
- Experience and understanding of Retail Pharmacies & Specialty Pharmacies
- Demonstrated ability to educate offices on access processes and issue resolution
- Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
- Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
- Advanced knowledge of medical insurance terminology
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
- Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
- Ability to manage ambiguity & problem solve
- Prepare and submit appropriate expense reports in a timely fashion
- Valid Driver’s License
We could treat some as Skills (solution oriented mindset, strong business acumen, analytic capabilities, etc.) but the instruction says to have sections only when posting has real specific content. We have both Requirements and Skills content. We could put the experience/education as Requirements, and the abilities/knowledge as Skills.
Thus:
Requirements
- 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
- 4-year degree in related field or equivalent experience
- Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
- The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
- Valid Driver’s License
Skills
- Solution oriented mindset, strong business acumen, & strong analytic capabilities
- Experience and understanding of Retail Pharmacies & Specialty Pharmacies
- Demonstrated ability to educate offices on access processes and issue resolution
- Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
- Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
- Advanced knowledge of medical insurance terminology
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
- Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
- Ability to manage ambiguity & problem solve
- Prepare and submit appropriate expense reports in a timely fashion
Now About the role: combine company description and summary.
We need to avoid repeating job title. Provide prose in . Could be two paragraphs.
Let's craft:
Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand’s lifecycle, with core passions in market access, patient services, field reimbursement, and data-driven analytics.
In this contracted, field-based role, the Access & Reimbursement Manager will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. This role will be highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff, which may include primary care, cardiology, and other client-defined specialties or account types, regarding access services and reimbursement solutions specific to the product and therapeutic area (Cardiovascular). The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform. Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE). As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role. In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.
Now Responsibilities: we need to list each bullet as - . Ensure we capture all points.
Let's compile responsibilities list:
1. Support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources.
2. Develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform.
3. Ensure understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape.
4. Abide in a compliant manner and work closely within a defined set Rules of Engagement (ROE).
5. As permitted under the approved program design and ROE, support patient-level access and reimbursement issue resolution and access PHI only as authorized and required to perform the role.
6. Demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients.
7. Have a direct impact on providing a positive experience for both the HCP Customer and Patient.
8. Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
9. Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials.
10. Provide in-person customer visits.
11. Participate in client meetings as appropriate.
12. Participate in regularly scheduled internal team and cross-functional meetings and calls.
13. Input call activity into customer CRM, as appropriate.
14. Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers.
15. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner.
16. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
17. Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff,
- for any list of duties/requirements/benefits. Use
for prose. We must preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc. The posting includes some boilerplate like "About Stratis Group:" and "Summary:" but those are substantive. We'll keep. We need to format: maybe first
About the role
then acontaining the company description and summary combined? Or separate paragraphs. The instruction: use
for prose. So we can put the descriptive text in
. Then responsibilities as
Responsibilities
then- each bullet. Requirements as
Requirements
then- . Skills as
Skills
then- . Ensure we don't repeat job title.
We need to extract bullet points from responsibilities and desired job requirements.
Let's parse responsibilities from the text:
From "Summary:" paragraph: It includes many sentences describing role. Might be considered responsibilities but we can treat as part of About the role. However we need to separate responsibilities list.
The responsibilities list appears after "Additional Responsibilities Include". Let's extract:
- Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
- Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
- Provide in-person customer visits.
- Participate in client meetings as appropriate.
- Participate in regularly scheduled internal team and cross-functional meetings and calls.
- Input call activity into customer CRM, as appropriate.
- Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers.
- Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner.
- Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
- Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
- Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
- Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.
Also earlier responsibilities: "The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources." etc. But we can incorporate those into responsibilities list as well.
Better to gather all responsibility statements:
From summary paragraph:
- The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources.
- The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform.
- Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape.
- The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE).
- As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role.
- In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients.
- The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.
Then the "Additional Responsibilities Include" list above.
We should combine all into one responsibilities list, preserving each distinct point.
Now Desired Job Requirements:
- 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
- 4-year degree in related field or equivalent experience
- Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
- The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
- Solution oriented mindset, strong business acumen, & strong analytic capabilities
- Experience and understanding of Retail Pharmacies & Specialty Pharmacies
- Demonstrated ability to educate offices on access processes and issue resolution
- Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
- Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
- Advanced knowledge of medical insurance terminology
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
- Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
- Ability to manage ambiguity & problem solve
- Prepare and submit appropriate expense reports in a timely fashion
- Valid Driver’s License
We could treat some as Skills (solution oriented mindset, strong business acumen, analytic capabilities, etc.) but the instruction says to have sections only when posting has real specific content. We have both Requirements and Skills content. We could put the experience/education as Requirements, and the abilities/knowledge as Skills.
Thus:
Requirements
- 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
- 4-year degree in related field or equivalent experience
- Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
- The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
- Valid Driver’s License
Skills
- Solution oriented mindset, strong business acumen, & strong analytic capabilities
- Experience and understanding of Retail Pharmacies & Specialty Pharmacies
- Demonstrated ability to educate offices on access processes and issue resolution
- Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
- Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
- Advanced knowledge of medical insurance terminology
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
- Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
- Ability to manage ambiguity & problem solve
- Prepare and submit appropriate expense reports in a timely fashion
. Could be two paragraphs. Let's craft:
Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand’s lifecycle, with core passions in market access, patient services, field reimbursement, and data-driven analytics.
In this contracted, field-based role, the Access & Reimbursement Manager will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. This role will be highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff, which may include primary care, cardiology, and other client-defined specialties or account types, regarding access services and reimbursement solutions specific to the product and therapeutic area (Cardiovascular). The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform. Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE). As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role. In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.
Now Responsibilities: we need to list each bullet as - . Ensure we capture all points. Let's compile responsibilities list: 1. Support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. 2. Develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform. 3. Ensure understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. 4. Abide in a compliant manner and work closely within a defined set Rules of Engagement (ROE). 5. As permitted under the approved program design and ROE, support patient-level access and reimbursement issue resolution and access PHI only as authorized and required to perform the role. 6. Demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. 7. Have a direct impact on providing a positive experience for both the HCP Customer and Patient. 8. Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients. 9. Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials. 10. Provide in-person customer visits. 11. Participate in client meetings as appropriate. 12. Participate in regularly scheduled internal team and cross-functional meetings and calls. 13. Input call activity into customer CRM, as appropriate. 14. Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. 15. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner. 16. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution. 17. Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff,
- . Ensure we don't repeat job title.
We need to extract bullet points from responsibilities and desired job requirements.
Let's parse responsibilities from the text:
From "Summary:" paragraph: It includes many sentences describing role. Might be considered responsibilities but we can treat as part of About the role. However we need to separate responsibilities list.
The responsibilities list appears after "Additional Responsibilities Include". Let's extract:
- Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
- Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
- Provide in-person customer visits.
- Participate in client meetings as appropriate.
- Participate in regularly scheduled internal team and cross-functional meetings and calls.
- Input call activity into customer CRM, as appropriate.
- Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers.
- Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner.
- Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
- Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
- Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
- Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.
Also earlier responsibilities: "The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources." etc. But we can incorporate those into responsibilities list as well.
Better to gather all responsibility statements:
From summary paragraph:
- The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources.
- The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform.
- Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape.
- The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE).
- As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role.
- In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients.
- The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.
Then the "Additional Responsibilities Include" list above.
We should combine all into one responsibilities list, preserving each distinct point.
Now Desired Job Requirements:
- 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
- 4-year degree in related field or equivalent experience
- Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
- The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
- Solution oriented mindset, strong business acumen, & strong analytic capabilities
- Experience and understanding of Retail Pharmacies & Specialty Pharmacies
- Demonstrated ability to educate offices on access processes and issue resolution
- Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
- Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
- Advanced knowledge of medical insurance terminology
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
- Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
- Ability to manage ambiguity & problem solve
- Prepare and submit appropriate expense reports in a timely fashion
- Valid Driver’s License
We could treat some as Skills (solution oriented mindset, strong business acumen, analytic capabilities, etc.) but the instruction says to have sections only when posting has real specific content. We have both Requirements and Skills content. We could put the experience/education as Requirements, and the abilities/knowledge as Skills.
Thus:
- . Skills as
- each bullet. Requirements as