Field Reimbursement Manager

This is a fully remote position, open to applicants in Arizona, +3 more states.

📋 Description

• Address intricate patient access challenges across the Hub and provider offices while liaising with the client field team.

• Collaborate with Sales, Payer Teams, Marketing, Healthcare Providers (HCPs), and Specialty Pharmacies to formulate strategic reimbursement support strategies.

• Inform HCPs and office personnel about Patient Support Programs and patient pathways.

• Facilitate onsite training for HCP offices regarding program business regulations, payer coverage, various J-codes, and reimbursement processes.

• Assist providers in navigating prior authorization and appeals procedures, including documentation, payer criteria, and communication of outcomes.

• Oversee daily operations to support patient access to client products across pertinent care settings.

• Analyze billing and coding, resolve reimbursement challenges, and avert future reimbursement obstacles.

• Coordinate with patient support services representatives on patient cases and claims matters.

• Train office personnel on patient assistance and reimbursement support services, including web-based provider programs and tools.

• Perform regional payer policy monitoring for coding, coverage, and payment.

• Educate providers about local payer coverage and reimbursement trends through training sessions.

• Conduct sales training related to product reimbursement as necessary.

• Communicate reimbursement issues to internal stakeholders, including Sales and Managed Markets.

• Track national and regional payer trends and modifications.

• Work alongside Managed Markets to escalate potential payer challenges.

• Ensure compliance with HIPAA and program guidelines.

• Meet training deadlines for corporate policies regarding confidential data.

• Consistently adhere to all Standard Operating Procedures (SOPs) and Business Requirement Documents (BRDs).

⛳️ Requirements

• Associate's degree or higher in a relevant field or equivalent market experience.

• 3+ years of experience in the Pharma/Healthcare sector, dealing with specialty products, Hubs, Payers, HCPs, or a similar domain.

• Preferably, direct experience with specialty dermatology products.

• Specific experience in practice management, billing, and/or coding for pharmaceuticals, biologicals, or devices.

• General knowledge of payer policies, including both public and private payers.

• Foundational understanding of medical benefit verifications and prior authorization/pre-determination requirements.

• Familiarity with reimbursement processes across various sites of care.

• Ability to provide virtual and field-based reimbursement support and education.

• Experience with prior authorizations, reimbursement billing, coding, and appeals procedures.

• Knowledge of commercial payer, Medicare, and Medicaid structures, systems, and reimbursement processes.

• Strong skills in stakeholder engagement and communication.

• Valid Driver’s License required when travel is necessary.

• Preferred typing speed of at least 35 words per minute with 97% accuracy.

• Willingness to travel as needed is preferred.

• Up to 10% travel may be required, plus additional travel for national meetings, training sessions, and POAs.

• Successful completion of a background check and, depending on the role, a drug screening.

🏝️ Benefits

• Medical, dental, and vision insurance plans, including HSA- and FSA-eligible options, with Valeris contributing to premium costs.

• Access to Telehealth and Employee Assistance Program (EAP) services.

• Company matching on Health Savings Account contributions.

• Complimentary Basic Life and AD&D coverage equivalent to annual earnings, with a minimum of $50,000 and a maximum of $300,000.

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

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

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays plus two floating holidays.

• Opportunities for career advancement and personal and professional development.

• A challenging, stimulating work environment that encourages innovative ideas.

• An inclusive workplace and mission-driven culture.

• Background check and, depending on the position, drug screening in line with company standards.