Access & Reimbursement Manager (Tampa / Pensacola, FL)

The Lockwood Group®; Tallahassee (FL); Sur place; USD 65 000 - 90 000; Plein temps

Résumé du poste

Stratis Group in Tallahassee, FL is seeking an Access Reimbursement Manager to lead a regional education and access strategy for providers and staff. You will coordinate with HUB and call center teams to ensure smooth patient access and payer communication.

The ARM will drive payer education, resolve PHI-related issues within compliance, and partner with internal and external stakeholders to optimize reimbursement for products in the assigned territory.

Qualifications

• 3+ years in Managed Care, Field Reimbursement, Patient Services, or related roles.
• 4 year degree or 8+ years in healthcare settings; pharma industry preferred.
• Willingness to travel 3-4 days per week; territory resident required.
• Strong business acumen and analytical skills.
• Experience with specialty/biologic products and complex reimbursement.

Responsabilités

• Manage daily activities to support patient access and act as liaison to HUB and call center services.
• Visit offices in person as appropriate and participate in client meetings.
• Record call activity into the client CRM and communicate payer changes to stakeholders.
• Educate offices on formulary coverage, prior authorization, benefits investigations, appeals, and claims resolution.
• Educate physician office staff on client patient support services and provider portals.

Connaissances

Managed Care

Field Reimbursement

Patient Services

Sales (Specialty)

PHI Handling

CMS Compliance

Formation

Bachelors degree or 8+ years healthcare exp

Outils

CRM

Description du poste

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