Access & Reimbursement Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as a dedicated virtual resource for access and reimbursement, addressing evolving coverage requirements across client-specified regions.

• Quickly evaluate new geographic areas, build effective virtual relationships, and shift between territories while ensuring consistent support and service.

• Inform provider offices about payer requirements, reimbursement procedures, patient support services, and authorized access resources.

• Educate healthcare providers and office personnel on access services and reimbursement solutions for cardiovascular products and therapeutic areas.

• Design and implement territory access strategies and prioritize accounts according to client-defined goals.

• Collaborate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders.

• Record activities in the approved CRM platform.

• Assist in resolving patient-level access and reimbursement issues as permitted by program design and Rules of Engagement.

• Manage daily virtual interactions via phone, Zoom, Webex, Teams, and similar platforms.

• Provide support for field vacancies, white space, and overflow case management virtually.

• Take on new territory assignments while ensuring consistent program execution and customer support.

• Educate on Retail and Specialty Pharmacy prior authorizations, appeals, and denials.

• Participate in client, internal team, and cross-functional meetings and calls.

• Monitor payer policies, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access obstacles.

• Communicate pertinent payer and field insights to internal stakeholders.

• Provide office education on formulary coverage, utilization management criteria, coding, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution.

• Utilize only client-approved materials, messaging, processes, and resources.

• Identify and relay field access insights, payer trends, office workflow challenges, and reimbursement obstacles.

• Recognize and report adverse events, product complaints, and other reportable information in accordance with client policies and applicable regulations.

⛳️ Requirements

• Minimum of 3 years of experience in Managed Care, Field Reimbursement, Patient Services, Sales (Specialty or Biologics), or healthcare provider office management.

• Bachelor's degree in a related field or equivalent experience.

• Ability to swiftly adapt to new business environments, respond to changing coverage demands and territory priorities, while ensuring consistent customer support and program execution.

• Experience in Cardiovascular/Cardiology and Hospital Healthcare Systems is advantageous.

• Familiarity with Retail Pharmacies and Specialty Pharmacies.

• Capability to educate offices on access processes and problem resolution.

• Experience in educating healthcare professionals and office staff about client-specific Patient Service programs, such as copay assistance programs.

• Proven experience in delivering educational presentations in person or through Zoom, Webex, and/or Teams.

• Advanced understanding of medical insurance terminology.

• Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, particularly expertise in Medicare Part D for Pharmacy Benefit products.

• Ability to cultivate and sustain trusted relationships with internal partners and collaborate effectively in teams.

• Proficiency in managing ambiguity and problem-solving.

• Capability to prepare and submit expense reports promptly.

• Valid driver's license.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health insurance coverage.

• Opportunities for professional development and career advancement.

• Flexible work environment.

• Supportive team and company culture.