Field Reimbursement Manager, Market Access - Mid-Atlantic Region

About the role

The Field Reimbursement Manager (FRM) is a customer-facing access & reimbursement subject matter expert who provides education, support center integration and patient level issue resolution across the Pharmaceutical Diagnostic (PDx) portfolio. Customers range from Prescribers to Radiologists and Nuclear Medics and their associated office staff.

Responsibilities

• Will be subject matter expert on all reimbursement support programs, payer claim processes, and access issue resolution.
• Develop & perform On-boarding & In-service presentations (in-person and virtual) with new and existing customer accounts.
• Responsible for proactive customer (prescribers, office staff, imagers, etc.) education about the PDx portfolio’s Payer Coverage policies, reimbursement processes, patient services, and benefit investigation.
• Primary point of contact responsible for resolving general and patient specific access and reimbursement challenges by leveraging the required internal and external resources.
• Develop Access & Reimbursement tools and Guides and disseminate approved content related to product coverage, claims processing, prior authorizations, and appeals.
• Maintain ongoing communication with the Market Access Account Executives and Sales to provide field intelligence and prioritize key accounts regarding account interactions.
• Attend conferences to promote GEHC’s Patient Support Services.

Qualifications

• Bachelor’s degree or equivalent
• Minimum of 5 years’ experience in the US healthcare medical device, or pharmaceutical sector.
• Minimum of 3 years’ US FRM experience
• Knowledge of and experience with medical benefit reimbursement and payment mechanisms including medical coding, claims and billing processes.
• Comprehensive knowledge of Government (Medicare/Medicaid, etc.) & Commercial coverage/ reimbursement dynamics.
• Familiarity with provider office and hospital outpatient department reimbursement, regulations, customers, and account-based planning.
• Knowledge of the radiology authorization process including but not limited to understanding HCPCS, CPT, and ICD-10 codes and associated regulations.
• Experience working with HUB or reimbursement call center.
• Ability to establish close collaboration with strategic partners and peers and lead collaborative initiatives.
• Problem solving and decision-making skills with the ability to “think on feet” and suggest alternatives and solutions.
• Strong customer focus with an ability to build relationships, identify and resolved (access) challenges, and manage complex project skills.
• Ability to operate independently and successfully as a leader in a matrix environment.
• Highly organized, strategic thinker with excellent verbal and written presentation skills.
• Ability to travel to connect with customers, and field sales teams.
• Demonstrated competence with CRM systems, PowerPoint, Excel & Word.

Desired Characteristics

• Certified Professional Coding Certification.
• Experience in radiopharmaceuticals, imaging, or diagnostics.
• Product launch experience.