We are looking for a Field Reimbursement Manager(s) – Virtual and other, to provide education and support to appropriate providers and their offices/staff on reimbursement programs for designated therapeutic products in their defined geography / aligned accounts in a mostly virtual environment, but not exclusively.
|TITLE:||Field Reimbursement Manager – Virtual (FRMV)|
|CATEGORY:||Employee and Program Support|
|TYPE:||Exempt, Salary, Full Time|
|JOB NATURE:||Office and field-based position, Heavy phone and computer usage, Minimal lifting|
|JOB SUMMARY:||Field Reimbursement Manager(s) – Virtual and other, provide education and support to appropriate providers and their offices/staff on reimbursement programs for designated therapeutic products in their defined geography / aligned accounts in a mostly virtual environment, but not exclusively. FRMV’s may expect up to 30% required travel to visit clients in a live face-to-face setting. Under any scenario, they will manage daily activities that support appropriate patient access to products in provider offices and work as a liaison to other patient assistance and reimbursement support services.|
|JOB DUTIES:||Provide majority of engagements virtually using a multi-channel approach to enhance HCP experience, using approved tools, to support and address questions about coverage requirements and as necessary, provide in-person engagement
Offer assistance by supporting the entire reimbursement journey from Patient Enrollment or Initiation, access determination, payer prior authorization to appeal and/or denial requirements procedures and any required documentation
Educating physician office staff on the proper use of the patient assistance programs and call center support services, including web-based provider programs
Serve as payer expert for defined geography and proactively communicate changes to key stakeholders in a timely manner. Coordinating with other patient support service program representatives and with field sales forces, as necessary
Identifies market access trends from local, regional or national payers in territory, and partners, with purpose internally to enable appropriate patient access and/or externally to support patient pull-through. Maintain and grow knowledge of national, regional, local and account market dynamics including coverage and coding
Adapts and pivots to manage change and complexity; agility to flex when markets, policies and dynamics change; proactive and reactive managing through conflict; navigates complexity of accounts and patient journey. Maintain and grow knowledge of hub and specialty pharmacy channels to improve practice and patient support
Collaborate to share insights into customer needs, potential barriers and payer issues/opportunities for product access. Under guidance, provide reimbursement insights to local field teams and home office functions as needed.
Uncovering customer insights through effective questioning; critical thinking and problem solving; analyzing and disseminating data and information as appropriate to partners. Ability to flex and adapt to where there is the most need within a given territory (i.e. area with heavier volume).
|TRAINING, EDUCATION, EXPERIENCE:||Must be 18 years old or older.
Bachelor’s degree required, advanced degree preferred.
Minimum three years' experience in public or private third-party reimbursement arena or pharmaceutical industry in managed care, clinical support, and/or sales.
Specialty pharmacy experience required (ability to teach an office the entire process from script to product/therapy delivery)
Establishing relationships within a practice by working closely with them to help remove reimbursement barriers to specialty products for their patients
Ability to operate as a "team player" in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
|REQUIREMENTS:||Exhibit proficiency in Microsoft Office products
Excellent customer service skills (call center experience preferred)
Advanced problem solving, research and analytical skills
Advanced communication skills, both written and verbal
Data entry accuracy required
Ability to multi-task and manage time independently
Client interaction experience preferred
|JOB RELATIONSHIPS:||Works with varying levels of staff and in direct contact with HCP’s, Patients, and Clients.|
|TIME COMMITMENT:||Monday through Friday
40 work hours minimum, Full Time
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