Field Reimbursement Manager

Summary

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions in the healthcare value chain. The Field Reimbursement Manager will work to eliminate barriers for patients, resolving access issues and educating healthcare providers on billing and coding for client products.

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team
• Partner with Sales Team, Marketing, HCP, 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, and other reimbursement related activities
• 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 patient benefit options, prior authorization requirements, and alternate funding/financial assistance programs
• 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 are followed with consistency
• Conducts miscellaneous tasks or projects as assigned

Skills

• Associate's degree or higher in a related field or equivalent market experience
• 3+ years in Case Management Reimbursement Experience
• 3+ in the Pharma/Healthcare industry; working with 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 benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care
• Demonstrated ability to conduct field-based reimbursement support and education
• Experience with new product launches, reimbursement billing, coding, and appeals process
• Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process
• Strong presentation skills
• Travel is limited, but the job may require up infrequent travel for meetings with key accounts and training
• Valid Driver's License for those where travel required
• Preferred candidate location within the Western U.S. region with the ability to travel throughout the assigned Mountain West and West Coast territory, including key accounts across California, Washington, Oregon, Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, Alaska, and Hawaii, as business needs require

Qualifications

Must Haves

• Associate's degree or higher in a related field or equivalent market experience
• 3+ years in Case Management Reimbursement Experience
• 3+ in the Pharma/Healthcare industry; working with 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 benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care
• Demonstrated ability to conduct field-based reimbursement support and education
• Experience with new product launches, reimbursement billing, coding, and appeals process
• Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process
• Strong presentation skills
• Travel is limited, but the job may require up infrequent travel for meetings with key accounts and training
• Valid Driver's License for those where travel required

Nice to Haves

• Preferred candidate location within the Western U.S. region with the ability to travel throughout the assigned Mountain West and West Coast territory, including key accounts across California, Washington, Oregon, Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, Alaska, and Hawaii, as business needs require