Field Reimbursement Manager - Tennessee

Principal Duties And Responsibilities

• Proactively educate the purchaser (Clinic, ASC, or HOPD), prescriber and office personnel so they may help patients gain access to our products.
• Educate on coding of product and how to pull-through using J-codes, including payer specific instructions on reimbursement/billing with both government and private payers, using PRC approved materials.
• Reactively address access and reimbursement issues and provide necessary education for them to secure appropriate reimbursement and access.
• Provide PRC approved information related to product coverage, which may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state.
• Interact with healthcare professionals, to understand access and reimbursement issues and work toward resolution.
• Maintain communication with all cross-functional partners throughout interactions and follow through to resolution.
• Coordinate with field sales regarding prioritization of accounts to ensure targeted, timely lists of key accounts.
• Ensure ongoing communication with field sales regarding account follow-up plans.
• Serve as a primary point of contact for Market Access team for corporate accounts, distribution, HUB, and payer issues.
• Act as the HUB liaison to educate customers on appropriate available patient support programs. Explain financial assistance and other funding options available to patients for products. Help the practice understand how to enroll patients in appropriate programs. Advocate for product utilization for patient-specific access support needs.

Qualification Requirements

• BA/BS degree required.
• Minimum 5-7 years of prior reimbursement and access experience preferred.
• Minimum 3 years of other related pharma/biotech experience strongly preferred (e.g., Market Access, Sales, Product Marketing).
• Prior experience launching specialty therapeutics in “buy and bill” environment.
• Comprehensive understanding of medical benefit policies across payer types (Medicare, Medicaid, commercial, VA/DoD, etc.) and sites of care (HOPD, ASCs, Clinics).
• Ability to lead without authority within cross-functional groups and in a matrix organization.
• Exceptional professional communications and interpersonal/problem-solving skills necessary to interact with key decision makers (CFO, revenue cycle, and other c-suite level stakeholders).
• Demonstrated ability to identify key access barriers and design effective resolution plans.
• Ensures compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance.