Field Reimbursement Manager (FRM) - Mid Atlantic

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
• Coordinate with Hubs on individual patient cases, including patient support services and enrollment
• Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners
• 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
• Assist in resolving patient-specific coverage challenges when requested by healthcare providers

Requirements

• 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
• Ability to travel up to 60-70% domestically
• Valid driver’s license required

Preferred Qualifications

• 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

Competencies

• Accountability for Results – Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change
• Strategic Thinking & Problem Solving – Make decisions considering the long-term impact to customers, patients, employees, and the business
• Patient & Customer Centricity – Maintain an ongoing focus on the needs of our customers and/or key stakeholders
• Impactful Communication – Communicate with logic, clarity, and respect
• Influence at all levels to achieve the best results for Otsuka
• Respectful Collaboration – Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals
• Empowered Development – Play an active role in professional development as a business imperative

Pay

Minimum $134,615.00 – Maximum $201,250.00, plus incentive opportunity. The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate’s job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum.

Benefits

• Comprehensive medical, dental, vision, and prescription drug coverage
• Company-provided basic life, accidental death & dismemberment, short-term and long-term disability insurance
• Tuition reimbursement
• Student loan assistance
• Generous 401(k) match
• Flexible time off
• Paid holidays
• Paid leave programs
• Other company-provided benefits