Field Reimbursement Manager

📋 Description

• Educate healthcare providers (HCPs) about Patient Support Programs: Deliver reactive, approved, and customized education to healthcare professionals and their teams regarding available financial assistance programs for qualifying patients.

• Provide Expertise in Reimbursement: Inform HCPs and their office staff about the local payer landscape through virtual educational sessions, including national and regional payer policies, prior authorization criteria such as letters of medical necessity and appeals templates, quantity limits, stocking information, and suitable access pathways and processes for payers and pharmacy benefit managers (PBMs).

• Address Access Barriers: Assist HCPs in compliantly troubleshooting claims at retail pharmacies for eligible patients who have utilized patient support financial assistance programs.

• Stay Updated on Payer Policies: Keep abreast of national and regional payer policies, managed care, reimbursement trends, and pertinent healthcare regulations (e.g., Commercial, Medicare, and Medicaid).

• Collaborate with Field Team Representatives: Work with field team members to receive engagement requests and relay the outcomes of those interactions.

• Demonstrate Ethical Conduct: Serve as a role model for ethics and integrity in your work to foster a culture of compliance and build trust with external stakeholders.

• Communicate Access Issues: Relay access concerns and issues to the appropriate internal stakeholders.

• Comply with HIPAA Regulations: Operate in accordance with HIPAA within program guidelines.

• Adhere to Training Deadlines: Ensure timely completion of training for all corporate policies and procedures governing access to confidential data.

• Ensure Compliant Use of Resources: Use only approved materials, resources, and talking points compliantly.

• Follow SOPs and BRDs: Ensure consistent adherence to all Standard Operating Procedures (SOPs) and Business Requirements Documents (BRDs).

• Perform Miscellaneous Tasks: Conduct any additional tasks or projects as assigned.

⛳️ Requirements

• Bachelor’s degree.

• Over 5 years of experience in Case Management Reimbursement; experience with product launches is highly preferred.

• More than 5 years in the Pharmaceutical or Healthcare sector; experience working with Hubs, Payers, HCPs, or in related fields.

• Advanced knowledge of the U.S. reimbursement landscape, encompassing commercial and government payers, patient access support programs, and prior authorization criteria.

• Proven ability to conduct virtual access support and education.

• Exceptional written and verbal communication skills, along with presentation expertise to effectively educate a variety of stakeholders.

• Demonstrated capability to efficiently address and resolve access barriers to enhance patient access and affordability for prescribed therapies.

• Highly skilled in various IT tools to meet business requirements, including proficiency in Veeva CRM.

• A thorough understanding and strict compliance with all federal and state regulations and guidelines, including HIPAA.

🏝️ Benefits

• Medical, dental, and vision plans, with HSA- and FSA-eligible options, and contributions from Valeris toward premium costs.

• Additional health support services, including telehealth and Employee Assistance Program (EAP) services.

• Company matching contributions for Health Savings Account deposits.

• Complimentary Basic Life and Accidental Death & Dismemberment (AD&D) insurance equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000.

• Company-covered Short-Term Disability insurance, with the option to purchase Long-Term Disability coverage.

• 401(k) Retirement Savings Plan featuring a 100% match on the first 5% you contribute, with immediate vesting.

• Paid Time Off (PTO) and Sick Leave to promote work-life balance.

• Team members enjoy nine paid holidays plus two floating holidays.

• Opportunities for career advancement within a company that fosters personal and professional growth.

• A stimulating work environment that encourages innovative ideas.

• Work for an organization that values diversity and actively seeks to create an inclusive workplace.

• Be part of a mission-driven, inclusive culture where your contributions have a significant impact.