Access & Reimbursement Manager

The Lockwood Group, LLC; Denver (CO); On-site; USD 90,000 - 130,000; Full time

Job summary

Stratis Group is seeking an Access & Reimbursement Manager to support payer strategy and patient access in a field-based role across designated accounts. You will educate provider offices on payer requirements, reimbursement processes, and available patient services to ensure timely access for cardiovascular products.

The role emphasizes coordinating with sales, market access, hub partners, and other stakeholders, developing territory access plans, and maintaining compliant engagement with ROE.

Qualifications

• 3+ years of experience in Managed Care, Field Reimbursement, Patient Services, or Sales in healthcare settings.
• Knowledge of payer landscape, Medicare/Medicare Part D knowledge is beneficial.

Responsibilities

• Educate provider offices on payer requirements, reimbursement processes, and patient access services.
• Develop and execute a territory access plan and coordinate with matrix stakeholders such as sales, market access, patient services, and hub/specialty partners.
• Document activities in the CRM and monitor payer policy, formulary coverage, and prior authorization trends.

Job description

About Stratis Group: Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand’s lifecycle, our core passions include: market access, patient services, field reimbursement, and data-driven analytics.

Summary: In this contracted, field-based role, the Access & Reimbursement Manager will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. This role will be highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff, which may include primary care, cardiology, and other client-defined specialties or account types, regarding access services and reimbursement solutions specific to the product and therapeutic area. (Cardiovascular).

The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform. Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE). As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role.

In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.

Additional responsibilities include:

• Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
• Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
• Participate in client meetings as appropriate. Participate in regularly scheduled internal team and cross-functional meetings and calls. Input call activity into customer CRM, as appropriate.
• Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
• Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
• Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
• Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.

Desired Job Requirements:

• 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
• 4-year degree in related field or equivalent experience
• Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
• The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
• Solution oriented mindset, strong business acumen, & strong analytic capabilities
• Experience and understanding of Retail Pharmacies & Specialty Pharmacies
• Demonstrated ability to educate offices on access processes and issue resolution
• Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
• Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
• Advanced knowledge of medical insurance terminology
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
• Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
• Ability to manage ambiguity & problem solve
• Prepare and submit appropriate expense reports in a timely fashion
• Valid Driver’s License