Field Reimbursement Manager

This is a fully remote position, open to applicants in Connecticut, +5 more states.

📋 Description

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

• Collaborate with Sales, Payer Teams, Marketing, HCPs, and Specialty Pharmacies to develop strategic reimbursement support strategies.

• Provide education to HCPs and office personnel regarding Patient Support Programs, operational policies, and patient journeys.

• Facilitate onsite training for HCP offices on program business rules, payer coverage, various J-codes, and reimbursement activities as necessary.

• Assist healthcare providers in navigating prior authorization and appeals processes, encompassing documentation, payer requirements, and communication of outcomes.

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

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

• Coordinate with patient support services representatives regarding patient cases and claim-related issues.

• Inform office staff about patient assistance and reimbursement support services, including online provider tools.

• Perform policy surveillance across regional payers for coding, coverage, and payment regulations.

• Educate providers on local payer coverage and reimbursement trends through training programs.

• Conduct sales training related to product reimbursement as needed.

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

• Keep track of national and regional payer trends and modifications.

• Partner with Managed Markets to address potential payer concerns.

• Ensure compliance with HIPAA and program regulations.

• Meet training deadlines for corporate policies governing confidential data.

• Adhere consistently to all SOPs and BRDs.

⛳️ Requirements

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

• More than 3 years of experience in the Pharma/Healthcare sector, engaging with specialty products, Hubs, Payers, HCPs, or a related field.

• Must possess specific practice management, billing, and/or coding experience for pharmaceuticals, biologicals, or devices.

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

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

• Familiarity with reimbursement processes across various care settings.

• Capability to conduct reimbursement support and education both virtually and in the field.

• Experience with Prior Authorizations, reimbursement billing, coding, and the appeals process.

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

• Excellent stakeholder engagement and communication abilities.

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

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

• Preferred: direct experience with specialty dermatology products.

🏝️ Benefits

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

• Telehealth services and Employee Assistance Program (EAP) benefits.

• 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-paid Short-Term Disability coverage, with an 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 along with two floating holidays.

• Opportunities for career advancement and personal and professional development.

• Engaging and stimulating work environment that fosters innovative ideas.

• Inclusive workplace culture driven by a mission-oriented approach.

• Background check and, depending on the position, drug screening as conditions of employment.