Sr Field Reimbursement Manager-East

Job Summary

The Senior Field Reimbursement Manager (FRM) will report to the Market Access Director of National Accounts – Payers on the Market Access Team. The FRM will be primarily responsible for the overall reimbursement process which will require collaboration between the field sales force, market access team, and patient support services. The FRM will not interact with the patient directly. This is a field-based position. Candidates must reside within the territory for which they are applying. This position will initially be responsible for the Eastern US market area.

Responsibilities

• Gain a firm understanding of the clinical policies, coding guidelines, prior authorization protocol required to prescribe and process billing for FDA approved products.
• Quickly identify, communicate and resolve outstanding billing reimbursement issues to the Director of National Accounts – Payers.
• Inform Field Sales Team of reimbursement hurdles specific to their territory with respect to Replimune Compliance guidelines.
• Use approved materials and suggest any material updates needed to the Market Access team marketer.
• Manage reimbursement challenges through a well-defined triage process.
• Partner with the Director of National Accounts – Payer team on a routine basis to understand the clinical policies for Replimune FDA approved products.
• Use approved tools, such as dashboards, coding guides, etc., to assist in making a smooth and efficient overall patient journey.
• Proactively communicate with Market Access account team to gain a complete understanding of payer based medical policies and clinical criteria for use of FDA approved Replimune products.
• Assist in building, tracking and reporting on key performance indicators to monitor overall performance.
• Collaborate with other field reimbursement managers to implement best practices.
• Advise in the development of tools to be used in the field to assist in product reimbursement.
• Conduct updates to the Director of National Accounts – Payers on the status of approval and reimbursement for patients of FDA approved products.

Qualifications

• College Degree Required
• Five (5)+ years or relevant reimbursement experience preferably in oncology “Buy and Bill” settings, including community and academic center environments.
• Comprehensive knowledge and understanding of the payers in the US health care system, including Medicare, Commercial, Medicaid and other payer archetypes.
• Proven track record in product reimbursement and coding, preferably in Oncology, with the melanoma therapeutic area a plus.
• Strong knowledge of market access, patient access and support services, with an emphasis on payer and provider reimbursement.
• Demonstrated ability to develop working relationships with other teams to achieve a common goal.
• Strong organizational alignment around prioritization and focus to meet set goals.
• Ability to communicate with customers and stakeholders in a professional manner to build trust and credibility with health care providers.
• Travel as required to assist in the overall reimbursement process.

Compensation & Benefits

• Anticipated base pay range: $181,000-$234,500
• Annual performance incentive bonus
• New hire equity and ongoing performance-based equity
• Medical, dental, and vision insurance
• 401k match
• Flexible time off
• Paid holidays including year-end shutdown