Field Reimbursement Manager (Seattle, Denver or Salt Lake City)
Reporting Structure
The Field Reimbursement Manager (FRM) reports to the Associate Director, Field Reimbursement and has no direct reports.
Areas Managed
The FRM manages accounts in a specified region, focusing on Endocrinology.
Field Reimbursement Overview
The FRM is responsible for providing access and reimbursement education to healthcare providers (HCPs) and office personnel, including information regarding medical policies, prior authorization requirements, coding and billing, product access via buybill or specialty pharmacy, with the goal of minimizing barriers to therapy. The FRM also supports by providing general education and case-specific next steps for appeals process in response to prior authorization denials. This role involves investing time on-site with HCPs, assessing their access and reimbursement needs, and facilitating collaboration with various stakeholders.
Key Responsibilities
Partnering with cross-functional parties on overall account and territory strategy to maximize internal/external customer knowledge on payor policy and processes.
Serve as subject matter experts on issues of coverage, access and reimbursement by providing compliant, limited support to US health care providers (HCPs) and their office staff in navigating the reimbursement landscape for products of Recordati Rare Diseases Inc. (RRD) after the HCP made an independent decision to prescribe.
Collaborate with HCP staff and Specialty Pharmacy to follow up with accounts that have outstanding prior authorization or appeals submissions.
Be a subject matter expert on reimbursement and regional-specific access landscape. This includes payor policies, prior authorization requirements, denials, appeals, peer to peer and other education required to navigate access for coverage of company therapies.
Collaborate with cross-functional parties on individual case management needs related to HCP education on reimbursement issues.
Leverage all available resources including internal data to develop and execute account plans/call purpose.
Comply with all laws, regulations and policies that govern the conduct of company activities, work with the highest degree of professionalism and in accordance with the company’s code of Ethics and Business Conduct.
Comply with annual budget allocation within respective territory.
Perform additional duties as may be assigned.
Education And Experience
Bachelor’s degree.
Experience in working in field-based role working with provider offices and/or with patient support HUB services.
Minimum of five to seven years of experience in the healthcare and/or pharmaceutical industry.
Minimum of three years successful field reimbursement experience.
Minimum of two years of experience working with buy and bill and/or specialty pharmacy networks.
In-depth knowledge of the U.S. pharmaceutical market, specifically rare diseases.
Reimbursement or relevant managed care experience (buy-and-bill, prior authorization, coding, and appeals processes).
Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner.
Comfortable presenting in person or virtual to Healthcare practitioner office staff.
Superior communication skills (written and verbal) and efficient follow-through.
Knowledge And Skills
Strong relationship-building skills, with demonstrated ability to collaborate and operate across functions.
Strong planning and organizational skills; demonstrated decision-making ability.
Reliable transportation within territory.
Proficiency in Microsoft Office.
Demonstrated highest ethical standards.
Demonstrated effective problem-solving and decision-making capabilities.
Able to prioritize/multi-task effectively.
Excellent verbal and written communication skills.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee must be able to fly via commercial air carrier. This is largely a sedentary role; however, the employee frequently is required to travel outside the office and also stand; walk; use hands to finger, handle or feel; and reach with hands and arms; talk and hear. Occasionally is required to lift and/or move light to moderate weight up to 25 lbs.
Work Environment
This job operates in a professional remote environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Location/Travel
This position is a remote position with proximity to a major airport. This position requires approximately 30-40% travel (need based).
FLSA Classification
This position is classified as non-exempt under the Fair Labor Standards Act.