Field Reimbursement Manager

This is a fully remote position, open to applicants in Illinois, +7 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, healthcare providers (HCPs), and specialty pharmacies to develop strategic reimbursement support strategies.

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

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

• Assist healthcare providers in navigating prior authorization and appeals procedures.

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

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

• Collaborate with patient support services representatives on patient cases and claim-related issues.

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

• Conduct policy monitoring across regional payers concerning coding, coverage, and payment.

• Update providers on local payer coverage and reimbursement trends through educational initiatives.

• Lead sales training sessions focused on product reimbursement as necessary.

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

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

• Work with Managed Markets to escalate potential payer concerns.

• Adhere to HIPAA regulations and comply with relevant SOPs and BRDs.

• Meet training deadlines for corporate policies and procedures concerning confidential data.

⛳️ Requirements

• An Associate's degree or higher in a related field, or equivalent market experience.

• A minimum of 3 years in the pharmaceutical or healthcare sector, particularly with specialty products, Hubs, Payers, HCPs, or a similar area.

• Preferred direct experience with specialty dermatology products.

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

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

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

• Awareness of reimbursement processes within various healthcare settings.

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

• Proficiency in prior authorizations, reimbursement billing, coding, and appeals processes.

• Familiarity with commercial payer, Medicare, and Medicaid frameworks, systems, and reimbursement processes.

• Strong skills in stakeholder engagement and communication.

• A valid driver's license is required for travel when necessary.

• Ability to type a minimum of 35 words per minute with 97% accuracy is preferred.

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

🏝️ Benefits

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

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

• Company matching contributions to Health Savings Accounts.

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

• Company-sponsored Short-Term Disability coverage, with an option to purchase Long-Term Disability.

• 401(k) Retirement Savings Plan featuring 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 development.

• A challenging and stimulating work environment that fosters innovative ideas.

• An inclusive, mission-driven company culture.

• Up to 10% travel, with additional travel for national meetings, training sessions, and POAs.