Field Reimbursement Director

Responsibilities

• Leads and mentors by establishing clear objectives and performance metrics, including providing tactical guidance on complex reimbursement issues and ensuring the team has the necessary resources to meet customer needs.
• Establish team SOPs, KPIs, Development opportunities and oversee a structured performance management framework, including regular evaluations and feedback sessions.
• Identify training needs and coordinate development opportunities to enhance team performance and expertise in reimbursement practices while fostering a culture of continuous improvement and accountability.
• Ensure all reimbursement activities comply with legal, regulatory, and corporate guidelines, mitigating risks associated with non-compliance.
• Establish, monitor, report customer engagement, outcomes, and RL SOPs metrics.
• Lead Performance Reviews, including ride-alongs/co-travel to provide expertise and coaching: in account management, specialty pharmacy, patient assistance programs, buy & bill acquisition, policy reviews, claim reviews and processing.
• Proactively scan/review, identify, and report reimbursement trends with strong personal ownership for identifying and communicating solutions via cross-functional collaboration (e.g., HCPs receiving notification of policy changes, claim denials, underpayments, etc.) and engage payer team appropriately when patient access may be jeopardized.
• Maintain expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements.
• Able to travel adequately to cover territory, as well as overnight travel (~50%) and attendance at scheduled training and meetings.

Qualifications

• Bachelor’s Degree in Science, Business, or Marketing required. Advanced Degree (MPH, MBA ,MHA) preferred.
• Minimum of 10 years “direct” reimbursement/healthcare policy experience. Minimum of 3-5+ years previous field-based reimbursement team management experience, preferably with products within prelaunch or early launch phases.
• Experience with launching and supporting drug/ device combination products.
• Demonstrated subject matter expertise in US Payer/insurance coverage and marketplace, including Medicare, Medicare Advantage, VA/Tri-Care, Commercial and Medicaid.
• Cross-functional experience and strong interpersonal skills within a team environment, with experience leading by influence towards business result.
• Demonstrated excellent proven written and verbal communication skills with ability to speak to all levels of the organization as well as understand and use data in communications.