Field Reimbursement Manager – GI

This is a fully remote position, open to applicants in California.

📋 Description

• Act as the main field-based point of contact for education, assistance, and issue resolution with healthcare providers and their office staff regarding patient access to J&J Immunology therapies.

• Allocate up to 50% of your time on-site with healthcare providers to assess educational needs and foster collaboration among stakeholders.

• Provide education to healthcare professionals on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and payer coding requirements.

• Collaborate with sales representatives and key account managers while serving as the local reimbursement expert.

• Address urgent access and affordability issues for patients promptly.

• Partner with managed care colleagues to stay informed about current policies and potential future changes.

• Deliver field-based reimbursement and access support, education, and creative problem-solving in accordance with FRM Rules of Engagement.

• Establish strong, trust-based relationships with customers in designated Immunology accounts.

• Oversee territory logistics, routing, and account business planning.

• Sustain and enhance knowledge of market dynamics, coverage, and coding requirements.

• Expand understanding of hub and specialty distribution channels to enhance practice and patient support.

• Work collaboratively with internal J&J departments including marketing, sales, medical science, SCG, IBG, HCC, and PECS.

• Function as a subject matter expert on access and affordability solutions across Medicare, Medicaid Managed Care, Commercial, and other payer types.

• Conduct business in accordance with ethical, legal, and compliance standards and complete necessary training.

• Stay updated on product coverage, access knowledge, marketplace conditions, and stakeholder practices.

• Adapt to the healthcare ecosystem to tailor resources and messaging for healthcare professionals and staff.

⛳️ Requirements

• Bachelor’s degree (preferably in healthcare or business/public administration).

• A minimum of 5 years of relevant professional experience.

• Experience in Account Management and/or Reimbursement within a provider office setting, fostering strong customer relationships.

• Demonstrated knowledge of both pharmacy and medical/buy & bill benefits, coding, and billing.

• Experience in reimbursement or managed care, encompassing revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes.

• Proven ability to build relationships, collaborate, and influence across a matrix organization.

• Strong problem-solving skills to navigate complex access scenarios and identify timely solutions efficiently.

• Excellent written and verbal communication skills with effective follow-through.

• Experience with patient support HUB services.

• A valid US driver’s license and a driving record that meets company standards.

• Willingness to maintain up to 50% travel consistently.

• Permanent residence within the specified territory.

• An advanced business degree (MBA) or public health degree (MPH) is preferred.

• Experience in the immunology disease state is preferred.

• Advanced degree and/or relevant certifications in prior authorization and/or billing and coding are preferred.

• Understanding of Medicare, Medicaid, and private payer initiatives impacting reimbursement for pharmaceutical and biotechnology products is preferred.

• Familiarity with Salesforce.com CRM, Microsoft Word, and Excel is preferred.

• Commitment to learning emerging technologies such as AI is preferred.

🏝️ Benefits

• Consolidated retirement plan (pension).

• Savings plan (401(k)).

• Long-term incentive program.

• Vacation – 120 hours per calendar year.

• Sick time - 40 hours per calendar year; 48 hours per calendar year for employees residing in the State of Colorado; 56 hours per calendar year for employees residing in the State of Washington.

• Holiday pay, including Floating Holidays – 13 days per calendar year.

• Work, Personal, and Family Time - up to 40 hours per calendar year.

• Parental Leave – 480 hours within one year of the birth/adoption/foster care of a child.

• Bereavement Leave – 240 hours for an immediate family member; 40 hours for an extended family member per calendar year.

• Caregiver Leave – 80 hours within a 52-week rolling period.

• Volunteer Leave – 32 hours per calendar year.

• Military Spouse Time-Off – 80 hours per calendar year.