Field Reimbursement & Access Lead

Valeris; Springfield (IL); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health, dental, vision plans

HSA/FSA options

401(k) company match

Paid time off and holidays

Background checks & drug screen

Job summary

Valeris seeks an experienced Field Reimbursement Manager to help patients access therapies by resolving reimbursement barriers and educating provider offices on billing and coding. You will collaborate with HUB, payer, and sales teams to drive access strategies and manage prior authorizations across multiple sites of care.

You will act as the reimbursement SME, coordinating with HUB and patient support programs, reviewing coding requirements, and guiding providers through documentation and

Qualifications

• Direct experience with specialty dermatology products.
• Must have specific practice management, billing and/or coding experience.
• Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
• Demonstrated ability to conduct virtual and field-based reimbursement support and education.
• Experience with Prior Authorizations, reimbursement billing, coding, and appeals process.
• Knowledge of commercial payer, Medicare and Medicaid structure, systems, and reimbursement process.
• Strong stakeholder engagement and communication skills.

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team.
• Partner with client’s Sales Team, Payer Teams, Marketing, HCPs, and their Specialty Pharmacies to create and drive strategic reimbursement support approaches.
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
• Lead HCP offices in onsite education of program business rules, payer coverage including review of J-codes, and other reimbursement related activities.
• Guide healthcare providers through the prior authorization and appeals process, assisting with required documentation, payer-specific requirements, and outcome communication.
• Manage daily activities that support patient access to client’s products across sites of care as an extension of HUB reimbursement services.
• Review billing and coding for products, assist with resolving reimbursement issues, and educate to avoid future hurdles.
• Coordinate with client’s patient support services representatives on patient cases and claim issues.
• Educate office staff on client’s patient assistance and reimbursement tools and topics.

Skills

Field reimbursement

Payer policy knowledge

Dermatology products

Stakeholder engagement

Job description

Valeris seeks an experienced Field Reimbursement Manager to help patients access therapies by resolving reimbursement barriers and educating provider offices on billing and coding. You will collaborate with HUB, payer, and sales teams to drive access strategies and manage prior authorizations across multiple sites of care.

You will act as the reimbursement SME, coordinating with HUB and patient support programs, reviewing coding requirements, and guiding providers through documentation and