Field Reimbursement Manager (FRM) - Greater NY

About the role

The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and Rare Disease. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.

Responsibilities

• Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements
• Analyze payer criteria and provide product access expertise to healthcare offices
• Collaborate with Hubs on individual patient cases, including patient support services and enrollment
• Manage daily field-based activities, spending 60-70% of time interacting with key stakeholders across various care sites
• Execute collaborative territory plans through partnerships with internal and external stakeholders
• Review and educate offices on payer policies, including prior authorization requirements
• Provide feedback to internal teams on local payer trends and access issues
• Aid in resolving patient-specific coverage challenges when requested by healthcare providers

Qualifications

• Bachelor's degree
• 5+ years of pharmaceutical industry experience, with focus on payer policy and reimbursement
• 3+ years of experience in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease
• Preferred: Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D
• Experience in "Buy and Bill" reimbursement environment
• Nephrology experience strongly preferred
• Comprehensive understanding of US healthcare system payer billing practices
• Proficiency in MS Office suite

Skills

• Excellent verbal and written communication skills
• Strong interpersonal and consultative abilities
• Self-directed with outstanding organizational skills
• Ability to build and maintain strong relationships with internal and external customers
• Proficient in delivering training and presentations

Benefits

Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.

Pay

$134,615.00 - $201,250.00, plus incentive opportunity

Schedule

Ability to travel up to 60-70% domestically

Contact

For more information about Otsuka and our benefits offerings, visit: https://www.otsuka-us.com/careers-join-otsuka

Disclaimer

Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka’s call center at: 800-363-5670. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: https://www.ic3.gov, or your local authorities.