Field Reimbursement Manager, Retina

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

📋 Description

• Facilitate pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices.

• Guide practices in submitting claims with new permanent J-Code HCPCS codes and assist with the transition once ASP is established.

• Oversee initial claim submissions and address payer rejections or clearinghouse formatting issues.

• Offer reimbursement, coverage, and access expertise to retina practices, ASCs, and hospital outpatient departments.

• Train clinic staff, billing teams, and practice managers on payer policies, prior authorization, claims submission, and J-code, CPT, and ICD-10 coding.

• Evaluate and assist in resolving denied claims, underpayments, and complex appeals with compliant guidance.

• Advise practices on buy-and-bill operations, specialty pharmacy fulfillment, inventory management, and co-pay or patient assistance programs.

• Monitor local commercial and Managed Medicaid policy determinations and communicate market updates to internal launch teams.

• Educate clinic staff on utilizing the Patient Support Program Hub for benefits verification and prior authorization assistance.

• Collaborate with Field Sales, Key Account Managers, Patient Support Services, Compliance, Finance, Distribution, and Training departments.

• Prepare accounts for launch, alleviate billing uncertainties, expedite time-to-treatment, and enhance confidence in reimbursement processes.

• Report directly to the Director of Retina Field Reimbursement.

⛳️ Requirements

• A minimum of 2 years of direct experience in executing buy-and-bill product launches in the specialty biologic or pipeline sector.

• Prior experience in Ophthalmology/Retina is highly preferred.

• Comprehensive understanding of Medicare Part B, ASP models, Medicare Part D, commercial insurance, Medicaid, and specialized Hub reimbursement services.

• Capability to thrive in a fast-paced product launch environment with changing payer policies.

• Outstanding presentation skills with the ability to simplify complex financial and billing rules.

• Strong problem-solving abilities for addressing rejected claims.

• Strict compliance with HIPAA, OIG guidelines, and company compliance policies.

• Proven success in collaborating within a matrixed environment.

• Extensive proficiency in Microsoft Office applications: Word, Excel, PowerPoint, Teams, and Outlook.

• Proficient in using CRM platforms.

• Willingness to travel approximately 50%, including overnight trips.

• Bachelor's degree is required.

• Over 6 years of experience in the pharmaceutical/biotech industry, specifically in medical reimbursement, patient access, or field reimbursement.

• More than 6 years of experience supporting buy-and-bill products in ophthalmology, rare disease, or specialty pharmaceuticals is preferred.

• An advanced degree or coding certification such as CPC, CHC, or PACs is a plus.

🏝️ Benefits

• Employer-paid medical, dental, and vision insurance.

• Paid time off (PTO).

• Life and disability insurance.

• Paid parental leave.

• Competitive 401(k) company match.

• Flexible and entrepreneurial work environment.

• Inclusive culture.

• Opportunity to influence the future of the company.