Access Reimbursement Manager

The Lockwood Group®; Hartford (CT); On-site; USD 95,000 - 130,000; Full time

Job summary

Stratis Group seeks an Access Reimbursement Manager to lead a dedicated territory, educating providers on access services and reimbursement solutions. You will partner with HUB, Call Center, and Market Access teams to improve patient access and insurer approvals, while ensuring PHI privacy and regulatory compliance.

The role requires field visits, payer expertise, strong communication, and the ability to travel 3-4 days per week within the assigned geography, residing within the territory.

Qualifications

• 3+ years in Managed Care, Field Reimbursement, Patient Services, or healthcare sales.
• Experience with payer communications and education to physicians' offices.

Responsibilities

• Manage daily activities to support patient access in provider offices and liaise with HUB/Call Center/ specialty services.
• Act as extension of client's HUB; conduct in-person or remote visits as appropriate.
• Participate in client meetings and team calls; log activities in CRM.
• Serve as payer expert; communicate payer changes to stakeholders promptly.
• Provide education on access processes, formulary coverage, prior authorizations and appeals.
• Educate office staff on patient support services and provider portals.

Skills

Managed Care

Field Reimbursement

Patient Services

Sales (Specialty/Biologics)

Education

4 year degree or 8+ years in related healthcare roles

Tools

CRM systems

Zoom/Webex/Teams

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 role, the Access Reimbursement Manager (ARM) is a client-facing and client-customer facing role that will be responsible for managing a dedicated territory to support access for provider and patients. This role will be highly visible within the organization and responsible for providing education to healthcare providers and office staff on access services and reimbursement solutions specific to a product and therapeutic area. The ARM will execute a region or territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and/or other matrix field partners. Responsibilities include ensuring understanding of the reimbursement process, field reimbursement services, and client's patient support program. The ARM will also work on patient-level reimbursement issue resolution, and thus will need access to and have had experience with patient health information (PHI). The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement. 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 (i.e. HUB, Call Center, Specialty Pharmacy Services).
• Act as an extension of client's HUB, as appropriate and provide in-person customer visits.
• Participate in client meetings as appropriate. Participate in regularly scheduled team meetings and calls. Input call activity into customer CRM, as appropriate.
• Serve as payer expert for defined geography and able to communicate payer changes to key stakeholders in a timely manner.
• Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
• Educate offices using approved educational materials provided by the client.
• Review specific patient case information, in a compliant manner, defined by the client.
• Educate physician office staff on the use of our client's patient support services, including web-based provider portals.

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 practice management
• 4 year degree or 8+ years in related healthcare roles and/or pharmaceutical or medical industry
• Ability to travel 3-4 days a week, with overnights and flights (as needed), must reside within the territory
• Solution oriented mindset, strong business acumen, & strong analytic capabilities
• Experience with specialty/biologic products and/or complex reimbursement process
• Demonstrated ability to educate offices on access processes and issue resolution
• Experience educating HCPs on client specific Patient Service programs (i.e. copay, nurse education, bridge, patient assistance, etc.)
• 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 B – for buy & bill products and Part D for Pharmacy products)
• Ability to manage ambiguity & problem solve
• Prepare and submit appropriate expense reports in a timely fashion
• Valid Driver's License