Field Reimbursement Manager (New England)

About the Role

In this contracted role, the Field Reimbursement Manager (FRM) is a client-facing and client-customer-facing position responsible for managing a dedicated territory to support access for providers and patients. This role is highly visible within the organization and focuses on providing education to primary care and cardiology-specific healthcare providers and office staff on access services and reimbursement solutions for a specific product and therapeutic area (Cardiovascular). The FRM will execute a region or territory strategic plan through partnership with internal and external stakeholders, including sales, market access, and other matrix field partners.

Responsibilities

• Ensure understanding of the reimbursement process, particularly in Retail Pharmacy, field reimbursement services, and payer landscape.
• Work on patient-level reimbursement issues without accessing PHI, adhering to a compliant manner and defined Rules of Engagement.
• Help offices obtain insurance authorization and/or reimbursement of products for appropriate patients, demonstrating a compliant and consultative approach.
• Manage daily activities to support appropriate patient access to the client's products in provider offices and act as a liaison to other patient assistance and access support services.
• Provide expertise in Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials.
• Conduct in-person customer visits and participate in client meetings as needed.
• Engage in regularly scheduled internal team and cross-functional meetings and calls.
• Input call activity into the customer CRM system.
• Serve as a payer expert for a defined geography, communicating payer changes to key stakeholders promptly.
• Educate offices on the entire access process, including formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and claims resolution.
• Use approved educational materials provided by the client to educate offices.

Requirements

• 3+ years of experience in Managed Care, Field Reimbursement, Patient Services, Sales (Specialty or Biologics), or healthcare provider office practice management.
• 4-year degree in a related field or equivalent experience.
• Cardiovascular/Cardiology and Hospital Healthcare Systems experience is a plus.
• Ability to travel 3-4 days a week, with overnights as needed, and reside within the Territory.
• Solution-oriented mindset, strong business acumen, and strong analytic capabilities.
• Experience and understanding of Retail Pharmacies and Specialty Pharmacies.
• Demonstrated ability to educate offices on access processes and issue resolution.
• Experience educating HCPs and office staff on client-specific Patient Service programs (e.g., copay).
• Experience delivering educational presentations in person and via technology platforms like Zoom, Webex, and Teams.
• Advanced knowledge of medical insurance terminology.
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare (Part D for Pharmacy Benefit products).
• Proven ability to develop and maintain trusted relationships with internal partners and work effectively in teams.
• Ability to manage ambiguity and problem-solve.
• Prepare and submit expense reports in a timely manner.
• Valid Driver's License.