Field Reimbursement Manager

This is a fully remote position, open to applicants in North Carolina, +4 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, HCPs, and specialty pharmacies to formulate strategic reimbursement support strategies.

• Provide education to HCPs and office personnel regarding Patient Support Programs, operating procedures, and patient pathways.

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

• Assist providers through the prior authorization and appeals procedures, including documentation, payer stipulations, and outcome communication.

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

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

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

• Inform office personnel about patient assistance and reimbursement support services, including online provider programs and resources.

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

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

• Lead sales training related to product reimbursement as necessary.

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

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

• Work alongside Managed Markets to escalate potential payer issues.

• Ensure compliance with HIPAA and adhere to program guidelines, SOPs, and BRDs.

• Meet training deadlines for corporate policies governing confidential data.

⛳️ Requirements

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

• 3+ years of experience in the pharmaceutical/healthcare sector, dealing with specialty products, Hubs, Payers, HCPs, or a similar area.

• Direct experience with specialty dermatology products is preferred.

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

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

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

• Familiarity with reimbursement processes across various care settings.

• Capability to deliver 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 frameworks, systems, and reimbursement processes.

• Excellent stakeholder engagement and communication abilities.

• Valid driver's license required when travel is necessary.

• Ability to type at least 35 words per minute with 97% accuracy is preferred.

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

🏝️ Benefits

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

• Telehealth and Employee Assistance Program (EAP) services.

• Company match on Health Savings Account contributions.

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

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

• 401(k) Retirement Savings Plan with 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 advancement and personal and professional development.

• Dynamic and stimulating work environment that promotes innovative ideas.

• Diverse, mission-driven culture.

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