Field Reimbursement Manager, Rheumatology

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

📋 Description

• Act as the main field-based leader for education, assistance, and problem-solving related to patient access for J&J Immunology therapies.

• Dedicate up to 50% of your time on-site with healthcare providers, evaluating educational needs and fostering collaboration among stakeholders.

• Provide training to healthcare providers and office personnel on product coverage, prior authorizations, appeals, reimbursement procedures, claims submissions, and payer coding requirements.

• Work alongside sales representatives and key account managers as the local expert on reimbursement.

• Respond urgently to significant patient access and affordability challenges.

• Collaborate with managed care colleagues to understand existing policies and potential modifications.

• Offer field-based reimbursement and access support, education, and innovative problem-solving in compliance with FRM Rules of Engagement.

• Establish trust-based relationships with clients across assigned Immunology accounts.

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

• Keep up-to-date with national, regional, local, and account market dynamics, including coverage and coding requirements.

• Gain insights into hub and specialty distribution channels to enhance practice and patient support.

• Collaborate with internal teams, including marketing, sales, medical science, SCG, IBG, HCC, and PECS.

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

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

⛳️ Requirements

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

• At least 5 years of relevant professional experience.

• Experience in Account Management and/or Reimbursement within a hospital and/or provider office setting, with strong customer relationship-building skills.

• Proven expertise in pharmacy and medical/buy & bill benefits, as well as coding and billing.

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

• Ability to forge relationships, collaborate, and influence within a matrix organization.

• Strong problem-solving skills to navigate complex access challenges and identify solutions.

• Experience with patient support HUB services.

• Valid US driver’s license and driving record that meets company standards.

• Willingness to maintain up to 50% travel consistently.

• Permanent residence within the specified territory.

• Preferred: Experience in immunology disease states.

• Preferred: Advanced degree and/or relevant certifications in prior authorization and/or billing and coding.

• Strong understanding of market access and business acumen.

• Knowledge of Medicare, Medicaid, and private payer initiatives impacting pharmaceutical and biotechnology reimbursement.

• Technical knowledge of payer policies, including coding, coverage, and payment.

• Proficiency with Salesforce.com CRM, Microsoft Word, and Excel.

• Commitment to learning about emerging technologies such as AI.

🏝️ 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 for employees in Colorado; 56 hours for employees in 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 following 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 in a 52-week rolling period.

• Volunteer Leave – 32 hours per calendar year.

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