Field Reimbursement Manager

Endo; Kansas City (MO); On-site; USD 100,000 - 140,000; Full time

Job summary

The Endo Access and Reimbursement Team seeks a Field Reimbursement Manager to minimize access barriers for patients and providers in the Missouri, Kansas and surrounding region, with travel to Dallas, TX as needed. The FRM educates provider offices on Buy/Bill, prior authorizations, SP logistics, and reimbursement processes, partnering with patient support programs to enable timely treatments.

The role requires strong data analysis, cross-functional collaboration, and experience with payers,

Qualifications

• BS or equivalent is required; MBA or advanced degree preferred.
• 5-7 years of relevant experience in the Biopharma industry.
• Three years’ experience in 3rd party reimbursement and managed care.
• Superb knowledge of buy & bill and SP pathways.
• Experience managing vendor relationships and customer interactions.
• Sales management and/or account management experience desirable.

Responsibilities

• Serve as subject matter expert on reimbursement and prior authorization policies.
• Educate physician offices on Buy/Bill, SP logistics, and payer policies.
• Coordinate patient assistance and reimbursement services with Endo teams.
• Develop account plans to optimize access and acquisition.
• Analyze data to identify payer barriers and guide solutions.

Skills

Sales experience

Payer policy understanding

Communication skills

Data analytics (Tableau)

Education

BS or equivalent

MBA or advanced degree

Tools

Tableau

Job description

Job Description

The Field Reimbursement Manager (FRM) position is a critical front-line member of the Endo Access and Reimbursement Team. The main driver of Endo Pharmaceuticals and Patient Access is patients and assisting provider offices to help their patients get access to care to get them back to living their best lives. The FRM role is a field-based position whose job is to minimize access and reimbursement barriers for patients and providers.

Within their geography, the FRM provides access and reimbursement education to physician office personnel, billing staff/companies, HCPs, as well as anyone involved in the process of utilizing the product with the intention of minimizing barriers and increasing access to care. FRM education homes in on Endo Specialty therapies, how to buy and bill our products, acquire through specialty pharmacies and educate on office processes. FRMs also support provider offices on a reactive basis by providing education and guidance in response to PA denials and claim denials and/or underpayments. The FRM will leverage all data analytic tools to minimize delay in receiving treatment by working with internal and external customers.

Scope of Authority: Missouri, Kansas, Arkansas, Oklahoma (Candidate can also travel from Dallas, TX)

Key Accountabilities

Provider Account Support

• Subject matter expert for all reimbursement/access and acquisition logistical aspects of a high touch biologic medication for an orphan disease and testosterone products with multiple acquisition options within a changing payer landscape. This includes: payer policies, prior authorization requirements, denial and appeal process, peer to peer, and other education required to navigate access for the appropriate patients.
• Assists HCP offices with questions related to Buy/Bill BI management. Educate/Assist with Specialty Pharmacy (SP) understanding, expectations and logistics. Continually educate office staff on appropriate steps, educate on the importance of chart documentation, keep offices up to date on payer policies for Endo products and triage issues to the appropriate HUB and SP.
• Primary responsibilities include:
• Managing patient assistance and reimbursement support services offered to providers and related to patient access to buy/bill products.
• Coordinating with Endo’s patient support services program representatives.
• Educating office staff on the use of Buy/Bill products, patient assistance and reimbursement support services.
• Participating in sales training related to product reimbursement.
• Utilizing data to critically think through acquisition challenges from a variety of outlets including SP, Specialty Distributors and Title sales.
• Assist new offices from a reimbursement perspective to inform them about reimbursement issues as well as providing education on various MARC approved resources pertaining to reimbursement, acquisition and coding.
• Act in a compliant manner at all times.

Specialty Pharmacy (SP) Support

• FRMs work closely with the external and internal customers to troubleshoot any SP related issues. FRMs work closely with their NAE partner to manage any customer related issues directly with the SP’s.
• SP experience is critical. Each FRM should be an expert SP logistics and operations.
• FRMs must be able to analyze data and know how to make that data into actionable steps to facilitate patient access to ENDO products.
• Work closely with SP’s to understand logistical issues that arise and provide MARC approved resources and programs to facilitate patient access as well as communicate with SP’s to find resolutions to issues that arise at the SP.
• Identify gaps in knowledge of accounts from a SP process and help provide education for the account and physician.
• Develop short and long term account plans for key accounts with the goal of smoothing out the process of acquiring drug to optimize acquisition and patient journey.

Internal Partnerships

• Consistent, reliable, timely and high-quality support of the field, as well as all other internal commercial functions.
• Strong leadership role to the field teams by establishing a solutions-oriented approach, working with your Sales Representatives/ASMs to build and execute local plans to overcome barriers to Buy/Bill products access. Specific examples include:
• Identify in conjunction with the field, specific targeted accounts where the FRM will assist with product acquisition or SP dispense.
• Partner with the ASMs to build local business plans; participate in district business reviews as the expert resource on the reimbursement landscape from regional, district, state and local perspective.
• Provide the teams with actionable feedback (across the organization) on support programs such as the Helpline, copay card, SPP performance, so as to guide changes to improve access.
• Help educate the internal customers on managed market dynamics specific to SP’s/SD’s as well as local payor issues-needs. Track customer trends in order to help inform internal business decisions, e.g. Health care policy changes.
• Proactively use business analytics to understand common logistical issues in top accounts and proactively develop plans for education and to find solutions for better patient access to all supported specialty products. Ensure alignment with ASM and District Strategy.
• Provide support to sales representatives, ASMs and Internal Stakeholders on rules of engagement to educate and further clarify what is appropriate.

Advocacy

• Works with the field to identify potential payer advocates and supports the National Account Management team on issues relating to medical policy development and execution at the HCP level.
• Ensure all Endo approved promotional speakers have an in-depth understanding of billing/coding, logistics and payer coverage.

Qualifications

Education & Experience

• BS or equivalent is required; MBA or advanced degree preferred.
• 5-7 years of relevant experience in the Biopharma industry required.
• Three years’ experience in 3rd party reimbursement and managed care experience.
• Superb knowledge and operationalizing experience of buy & bill and SP pathways.
• Previous experience working with vendor relationships desirable.
• Previous experience managing customer interactions required.
• Previous sales management and/or account management experience highly desirable.
• All newly hired FRMs should enter at this level regardless of their tenure or experience elsewhere.

Knowledge

• Systemic understanding of the global payer and distribution environment, in particular, physician administered biologics in the U.S.
• Understanding of coverage, coding (diagnostic, procedural and product), payment and reimbursement requirements and policies.
• Knowledge/expertise in commercial payer policy.
• Knowledge/expertise in Local Coverage Determinations (LCDs) per each regional MAC for all ENDO products.
• Knowledgeable on Medicare billing/coding and appeal process. ASP, WAC as well as Sequestration; interpret and understand Medicare EOBs and CMS 1500 forms.
• Understands the legislative, legal and regulatory environments and anticipates potential impact to Endo.
• Solid understanding of coverage policy creation, interpretation, and management.

Skills & Abilities

• Significant sales experience in the biologic (injectable) market.
• Possess a strong understanding of commercial payers, Medicare Part B and D and Medicaid; particularly in assigned geography.
• Ability to have payer conversations with commercial and government payers, drawing on the understanding of Endo products, payer policy appeals process, and the payer landscape.
• Leverage all resources (Tableau and other portals) to develop and execute account support and educate sales colleagues.
• Ability to synthesize clinical literature and target product profile in order to understand implications for value to payers, patients and health care providers and Endo.
• Superior verbal, written, and presentation skills to effectively convey strategic and technical market access information, with an ability to condense complex information into concise outputs and direction.
• Ability to balance external stakeholders’ wants with Endo needs.
• Hands–on operational reimbursement experience – in-house and outsourced experience desirable.
• Demonstrated ability to work with multiple stakeholders in a collaborative and constructive manner. Establishes relationships with appropriate field personnel, accounts, payers and vendors.
• Model Endo’s vision and core values and encourages others to foster a culture of compliance.
• Conduct business at the c-suite level for large hospital systems and can address more routine policy and State Medicaid and Medicare problems.

Physical Requirements

Seniority level: Mid-Senior level

Employment type: Full-time

Job function: Sales and Other

Industries: Pharmaceutical Manufacturing