Field Reimbursement Manager

Valeris; Atlanta (GA); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, and vision plans with

Health Savings Account options

401(k) Retirement Savings Plan with 5%

Job summary

Valeris is seeking a Field Reimbursement Manager to support patient access across sites of care. You will educate offices on billing and coding for client therapies, lead onsite payer education, and collaborate with HUB teams and sales to improve access to treatment.

The role requires experience with prior authorizations, reimbursement processes, and knowledge of Medicare/Medicaid structures. Travel up to 10% is expected in a dynamic field role.

Qualifications

• 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.

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 miscellaneous J‑codes, and other reimbursement related activities.
• The FRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
• Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.
• Coordinate with client's patient support services programs representatives on patient cases and claim issues.
• Educate office staff on the use of client's patient assistance and reimbursement support services, including but not limited to web‑based provider programs and tools, and provide information on relevant reimbursement topics related to client's products.
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client's products.
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, as appropriate.
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
• Work collaboratively with Managed Markets team to upscale potential payer issues.
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data.

Skills

Prior Authorization experience

Coding experience

Billing experience

Education

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

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real‑life impact to build a world in which every patient gets the care they need.

Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and an exceptionally talented team, Valeris provides data, strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products.

Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana.

As a Field Reimbursement Manager (FRM), you will join our team on a journey to help eliminate barriers for patients to help increase their access to medications while working in an environment of collaboration. You will help resolve patient access issues, educate healthcare provider offices on appropriate billing and coding for client's products, and provide educational services within relevant sites of care. Additionally, the FRM role will work directly with office support staff, billing and coding staff, applicable third‑party vendors (HUB, Copay Card, Patient Assistance Program (PAP)), and other important stakeholders involved with supporting patient access to our client's therapies. The FRM will operate as the subject‑matter expert on medical benefit reimbursement, access, and coverage issues including Prior Authorization and Appeals.

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, resulting in increased access to therapy for individual patients.

Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.

On occasion, lead HCP offices in onsite education of program business rules, payer coverage including review of miscellaneous J‑codes, and other reimbursement related activities.

The FRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.

Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.

Coordinate with client's patient support services programs representatives on patient cases and claim issues.

Educate office staff on the use of client's patient assistance and reimbursement support services, including but not limited to web‑based provider programs and tools, and provide information on relevant reimbursement topics related to client's products.

Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client's products.

Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.

Lead sales training related to product reimbursement, as appropriate.

Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.

Work collaboratively with Managed Markets team to upscale potential payer issues.

On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data.

Qualifications

• Associate's degree or higher in a related field or equivalent market experience
• Worked with specialty products, Hubs, Payers, HCP or related area

Requirements

• 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.

Travel Requirements

• Job may require up to 10% travel
• Additional travel will be required for various national meetings, training programs and POAs
• Valid Driver's License for when travel is required
• Although very minimal, flexibility to travel as needed is preferred.

Working Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

We're committed to supporting the well‑being and success of our team members.

Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including telehealth and Employee Assistance Program (EAP) services
• Company match on Health Savings Account contributions
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
• Paid Time Off (PTO) and Sick Leave to support work‑life balance
• Team members receive nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• At Valeris, we don't just accept difference - we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community.