Field Reimbursement Manager - Long Island, NY ( Includes, Brooklyn, Queens and Long Island)

About the role

This role will be supporting the Respiratory business unit. The Territory Covers: Includes, Brooklyn, Queens and Long Island.

Responsibilities

• Act as an extension of the HUB, providing live one-on-one coverage support
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms
• Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges
• Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access
• Cook up access/reimbursement issues with relevant partners, including the HUB
• Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)
• Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders
• Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution
• Educate offices using approved materials
• Review patient insurance benefit options and alternate funding/financial assistance programs
• Collaborate with other departments to resolve reimbursement issues

Requirements

• Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge
• Proven presentation and facilitation skills
• Strong written and oral communication skills
• Organizational skills and project management experience, including the ability to manage multiple projects
• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers
• Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types
• Strong collaboration and ability to lead cross functional partner meetings
• Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region
• Live in the geography or less than 10 miles from the geography border

Qualifications

• Doctorate degree
• OR Masters degree and 3 years of customer service and/or leadership experience
• OR Bachelors degree and 5 years of customer service and/or leadership experience
• OR Associates degree and 10 years of customer service and/or leadership experience
• OR High school diploma / GED and 12 years of customer service and/or leadership experience

Skills

• Collaboration
• Customer service
• Leadership
• Medical reimbursement
• Public or private third-party access arena
• Pharmaceutical industry
• Managed care
• Clinical support
• Sales
• Presentation and facilitation
• Written and oral communication
• Organizational skills
• Project management
• Computer literacy
• Insurance verification
• Claim adjudication
• Physician's offices or clinics
• Pharmacies
• Pharmaceutical manufacturers
• Hubs
• Billing, coding, and appeals
• Commercial payers
• Medicare plans
• State Medicaid

Benefits

• A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
• A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
• Stock-based long-term incentives
• Award-winning time-off plans
• Flexible work models, including remote and hybrid work arrangements, where possible

Pay

The expected annual salary range for this role in the U.S. (excluding Puerto Rico) is $145,471.00 to $196,813.00. Actual salary will vary based on several factors including, but not limited to, relevant skills, experience, and qualifications.

Schedule

Remote, Work from Home. One to two home office days per week. Must be able to travel up to 60-80% via automobile or plane. Must have a valid driver's license with a clean driving record. Possible long periods of sitting and/or keyboard work.