Field Reimbursement & Access Strategist

Mercalis; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Valeris, a life sciences commercialization partner, seeks a Field Reimbursement Manager to reduce barriers to patient access by guiding billing, coding, and reimbursement for client therapies across care sites.

You will educate provider offices, coordinate with HUB, copay vendors, and manage prior authorizations and appeals while collaborating with Sales, Managed Markets and stakeholders.

Travel up to 10% is common; role is field-based with ongoing education and cross-functional collaboration.

Qualifications

• Associate's degree or higher in a related field or equivalent market experience.
• 3+ years in Pharma/Healthcare with specialty products, hubs, payers, or related area.
• Preferred: direct experience with specialty dermatology products.
• Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices.
• 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 with Hub, provider offices and client field team.
• Partner with client’s Sales Team, Payer Teams, Marketing, HCPs, and their Specialty Pharmacies to drive reimbursement support.
• Educate HCP and Office Staff on Patient Support Programs and policy operating guidelines.
• On occasion, lead HCP offices in onsite education of program business rules and payer coverage.
• Guide providers through prior authorization and appeals process with required documentation.
• Manage daily activities to support patient access across sites of care as an extension of HUB services.
• Review billing and coding for products, resolve reimbursement issues, and educate to avoid future hurdles.
• Coordinate with patient support representatives on cases and claim issues.
• Educate staff on client’s patient assistance and reimbursement tools and topics.
• Conduct policy surveillance across regional payers for coding, coverage and payment.
• Assist providers with understanding local payers and reimbursement trends via events.
• Lead sales training related to product reimbursement as appropriate.
• Communicate reimbursement concerns with Sales and Managed Markets.
• Monitor national and regional payer trends and work with Managed Markets on issues.
• Operate in compliance with HIPAA and training deadlines; follow SOPs and BRDs.

Education

Associate's degree or higher in a related field or equivalent market experience

Job description

Valeris, a life sciences commercialization partner, seeks a Field Reimbursement Manager to reduce barriers to patient access by guiding billing, coding, and reimbursement for client therapies across care sites.

You will educate provider offices, coordinate with HUB, copay vendors, and manage prior authorizations and appeals while collaborating with Sales, Managed Markets and stakeholders.

Travel up to 10% is common; role is field-based with ongoing education and cross-functional collaboration.