Field Reimbursement Manager - Remote (Great Planes/Great Lakes)

Summary

Valeris is an integrated life sciences commercialization partner that provides technology-enabled solutions across the healthcare value chain to improve patient access to medications. The Field Reimbursement Manager resolves patient access issues, educates healthcare providers on billing and coding, and serves as a subject-matter expert on medical benefit reimbursement, coverage, prior authorization, and appeals.

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team
• Partner with client’s Sales Team, Payer Teams, Marketing, HCPs, and their Specialty Pharmacies to create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey
• On occasion, lead HCP offices in onsite education of program business rules, payer coverage including review of miscellaneous J-codes, and other reimbursement related activities
• Guide healthcare providers through the prior authorization and appeals process, assisting with required documentation, payer-specific requirements, and outcome communication
• The FRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers
• Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles
• Coordinate with client’s patient support services programs representatives on patient cases and claim issues
• Educate office staff on the use of client’s patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to client’s products
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client’s products
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs
• Lead sales training related to product reimbursement, as appropriate
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets
• Understand and monitor national and regional payer trends and changes
• Work collaboratively with Managed Markets team to escalate potential payer issues
• Operate in Compliance with HIPAA within program guidelines
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
• Ensure all SOPs and BRDs are followed with consistency

Skills

• Associate's degree or higher in a related field or equivalent market experience
• 3+ in Pharma/Healthcare industry; working with specialty products, Hubs, Payers, HCP or related area
• Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices
• Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care
• Demonstrated ability to conduct virtual and field-based reimbursement support and education
• Experience with Prior Authorizations, reimbursement billing, coding, and appeals process
• Knowledge of commercial payer, Medicare and Medicaid structure, systems, and reimbursement process
• Strong stakeholder engagement and communication skills
• Job may require up to 10% travel
• Additional travel will be required for various national meetings, training programs and POAs
• Valid Driver's License for when travel is required
• Preferred: direct experience with specialty dermatology products
• Preference will be given for candidates residing in the following states: Montana, Wyoming, Colorado. North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa Missouri Wisconsin, Michigan, Idaho, Utah Indiana

Qualifications

Must Haves

• Associate's degree or higher in a related field or equivalent market experience
• 3+ in Pharma/Healthcare industry; working with specialty products, Hubs, Payers, HCP or related area
• Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices
• Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care
• Demonstrated ability to conduct virtual and field-based reimbursement support and education
• Experience with Prior Authorizations, reimbursement billing, coding, and appeals process
• Knowledge of commercial payer, Medicare and Medicaid structure, systems, and reimbursement process
• Strong stakeholder engagement and communication skills
• Job may require up to 10% travel
• Additional travel will be required for various national meetings, training programs and POAs
• Valid Driver's License for when travel is required

Nice to Haves

• Preferred: direct experience with specialty dermatology products
• Preference will be given for candidates residing in the following states: Montana, Wyoming, Colorado. North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa Missouri Wisconsin, Michigan, Idaho, Utah Indiana

Benefits

• Remote work arrangement