Field Reimbursement Manager

This is a fully remote position, open to applicants in Illinois, +9 more states.

📋 Description

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

• Collaborate with Sales, Payer Teams, Marketing, Healthcare Providers (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 pathways.

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

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

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

• Analyze billing and coding, resolve reimbursement challenges, and offer training to mitigate future complications.

• Coordinate with patient support services representatives on patient cases and claims-related issues.

• Inform office staff about patient assistance and reimbursement support services and digital provider tools.

• Conduct policy monitoring across regional payers.

• Educate providers on local payer coverage and reimbursement patterns through training initiatives.

• Lead training sessions for sales staff concerning product reimbursement.

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

• Track national and regional payer trends and developments.

• Work alongside Managed Markets to escalate potential payer challenges.

• Ensure compliance with HIPAA and program regulations.

• Adhere to training deadlines for corporate policies regarding confidential information.

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

⛳️ Requirements

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

• A minimum of 3 years in the Pharma/Healthcare sector, with experience in specialty products, Hubs, Payers, HCPs, or similar domains.

• Preferred direct experience with specialty dermatology products.

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

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

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

• Awareness of reimbursement processes across various care settings.

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

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

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

• Strong skills in stakeholder engagement and communication.

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

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

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

🏝️ Benefits

• Comprehensive medical, dental, and vision plans, including HSA- and FSA-eligible options, with contributions from Valeris towards 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 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 provisions.

• Nine paid holidays and two floating holidays.

• Opportunities for career advancement and personal development.

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

• An inclusive workplace with a mission-driven culture.

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