Virtual Reimbursement Manager

Responsibilities

• Reactively support multiple accounts in a specified geographic region through the access process.
• Execute the collaborative territory strategic plan through partnership with internal and external stakeholders, including sales, market access, and other collaboration partners.
• Ensure understanding of coverage, access process, and reimbursement services.
• Demonstrate unwavering support and a consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients.
• Have a direct impact on a patient's ability to access the therapies they need.
• Manage daily activities that support appropriate patient access to our client’s products in the provider offices.
• Serve as payer expert for defined geography and able to communicate payer changes to key stakeholders in a timely manner.
• Offer office education during the entire access process, which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, and appeals.
• Educate offices using approved materials provided by the client.
• Educate physician office staff on the use of our client’s patient support services, including web-based provider portals.

Requirements

• Demonstrated understanding of access, coverage, and reimbursement issues in the retail channel, including commercial and federal health care program utilization management tools such as prior authorization, step edits, and denials.
• Demonstrated ability to educate offices on access processes, including but not limited to: experience educating HCPs on client-specific Patient Support programs (i.e., copay, bridge, patient assistance, etc.), experience delivering educational presentations.
• Advanced knowledge of medical insurance terminology.
• Expertise in Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B & D.

Qualifications

• Bachelor’s Degree.
• Minimum two years of experience in public or private third-party reimbursement or access arena or pharmaceutical industry in managed care or clinical support.

Skills

• Demonstrated initiative, resourcefulness, and a results-oriented mindset.

Benefits

• Competitive compensation package.
• Health benefits to include Medical, Dental, and Vision.
• Company match 401k.
• Flexible paid time off (PTO) and sick time.