Access & Reimbursement Manager

Jobtailor

San Francisco (CA)

On-site

USD 120,000 - 160,000

Full time

6 days ago

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Job summary

Jobtailor in San Francisco seeks a Field Reimbursement Manager to serve as a dedicated access and reimbursement resource within an assigned territory. You will educate provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources.

Develop and execute a territory access plan, coordinate with sales, hub partners, and cross-functional teams, and document activities in the CRM.

Qualifications

3+ years of experience in Managed Care, Field Reimbursement, Patient Services, Specialty or Biologics Sales, or healthcare provider office practice management
4-year degree in related field or equivalent experience
Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
Ability to travel 3-4 days a week, with overnights as needed, and reside within the Territory
Solution-oriented mindset, strong business acumen, and strong analytic capabilities
Experience and understanding of Retail Pharmacies and 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, such as copay programs
Experience delivering educational presentations in person and/or via Zoom, Webex, or Teams
Advanced knowledge of medical insurance terminology
Knowledge of CMS policies and processes, with expertise in Medicare Part D for Pharmacy Benefit products
Ability to develop and maintain trusted relationships with internal partners and work effectively in teams
Ability to manage ambiguity and problem solve
Ability to prepare and submit appropriate expense reports in a timely fashion
Valid Driver’s License

Responsibilities

Serve as a dedicated access and reimbursement resource within an assigned territory
Educate provider offices and staff on payer requirements, reimbursement processes, patient support services, and approved access resources
Support appropriate patient access for client products and resolve access issues
Develop and execute a territory access plan and prioritize accounts
Coordinate with sales, market access, patient services, hub/specialty pharmacy partners, and other stakeholders
Document activities in the approved CRM platform
Provide education on prior authorizations, appeals, denials, and formulary criteria
Conduct in-person customer visits and participate in client and cross-functional meetings
Monitor payer policy, formulary coverage, and denial patterns to identify barriers
Communicate payer changes and field insights to internal stakeholders
Provide education on coding, forms, benefits investigation, and claims resolution
Identify field access insights and reimbursement challenges
Report adverse events and other required information

Skills

Managed Care

Field Reimbursement

Patient Services

HCP Education

Analytics

Relationship Building

Presentations

Travel Ready

Education

Bachelor's degree

Tools

CRM Platform

Zoom

Webex

Microsoft Teams

Job description

Serve as a dedicated access and reimbursement resource within an assigned territory
Educate provider offices and office staff on payer requirements, reimbursement processes, patient support services, and approved access resources
Support appropriate patient access for client products, including access and reimbursement issue resolution as authorized
Develop and execute a territory access plan and prioritize accounts based on client-defined objectives
Coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders
Document activities in the approved CRM platform
Provide education on Retail and Specialty Pharmacy prior authorizations, appeals, and denials
Provide in-person customer visits and participate in client, internal, and cross-functional meetings and calls
Monitor payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers
Communicate relevant payer changes and field insights to internal stakeholders
Provide office education on formulary criteria, coding, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution
Use only client-approved materials, messaging, processes, and resources
Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges
Recognize and report adverse events, product complaints, and other reportable information according to policy and applicable requirements

Requirements

3+ years of experience in Managed Care, Field Reimbursement, Patient Services, Specialty or Biologics Sales, or healthcare provider office practice management
4-year degree in related field or equivalent experience
Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
Ability to travel 3-4 days a week, with overnights as needed, and reside within the Territory
Solution-oriented mindset, strong business acumen, and strong analytic capabilities
Experience and understanding of Retail Pharmacies and 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, such as copay programs
Experience delivering educational presentations in person and/or via Zoom, Webex, or Teams
Advanced knowledge of medical insurance terminology
Knowledge of CMS policies and processes, with expertise in Medicare Part D for Pharmacy Benefit products
Ability to develop and maintain trusted relationships with internal partners and work effectively in teams
Ability to manage ambiguity and problem solve
Ability to prepare and submit appropriate expense reports in a timely fashion
Valid Driver’s License

Core Competencies

Demonstrates expertise in access and reimbursement processes, with a strong focus on educating healthcare providers and office staff. Proficient in developing territory access plans and navigating payer policies to enhance patient access to client products.

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