Field Reimbursement Manager

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team.
• Partner with Sales Team, Marketing, HCP, Specialty Pharmacies to create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients.
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
• On occasion, lead HCP offices in onsite education of program business rules, payer coverage, and other reimbursement related activities.
• Manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
• Review patient benefit options, prior authorization requirements, and alternate funding/financial assistance programs.
• Avoid future reimbursement hurdles by assisting with appropriate billing and coding for products.
• Coordinate with client’s patient support services programs representatives on patient cases and claim issues.
• Provide information on relevant reimbursement topics related to client’s products to office staff.
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client’s products.
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, as appropriate.
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
• Understand and monitor national and regional payer trends and changes.
• Work collaboratively with Managed Markets team to escalate potential payer issues.
• Operate in Compliance with HIPAA within program guidelines.
• Ensure all SOPs are followed with consistency.

Qualifications

• Associate's degree or higher in a related field or equivalent market experience
• 3+ years in Case Management Reimbursement Experience
• 3+ in the Pharma/Healthcare industry; working with Hubs, Payers, HCP or related area
• Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices.
• Must have general payer policy knowledge including public and private payers, foundational knowledge of benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
• Demonstrated ability to conduct field-based reimbursement support and education
• Experience with new product launches, reimbursement billing, coding, and appeals process.
• Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process.
• Strong presentation skills