Field Reimbursement Manager

Mercalis Incorporated; Morrisville, Jeffersonville (NC, IN); On-site; USD 70,000 - 90,000; Full time

Job summary

Mercalis Incorporated is looking for a Field Reimbursement Manager based in North Carolina. You will help resolve patient access issues, educate healthcare providers on billing and coding, and work collaboratively with various stakeholders to increase patient access to medications.

The ideal candidate has at least 3 years of reimbursement experience and a strong understanding of the healthcare reimbursement landscape. This role offers the opportunity to make a significant impact in the healthcare space while supporting patients and providers.

Qualifications

• 3+ years in Case Management Reimbursement Experience.
• Experience with new product launches and reimbursement processes.
• Strong knowledge of payer policies for public and private payers.

Responsibilities

• Resolve patient access issues and educate healthcare providers.
• Partner with sales teams to increase access to therapies.
• Conduct policy surveillance for appropriate coding and coverage.

Skills

Case Management Reimbursement Experience

Billing and Coding Experience

Presentation Skills

Knowledge of Reimbursement Processes

Education

Associate's degree or higher in a related field

Job description

Overview

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 exceptionally talented team members, Valeris provides the data and 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. To learn more about Valeris, please visit www.valeris.com.

Responsibilities

WEST COAST TERRITORY

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, third party vendors (HUB, Copay Card, Patient Assistance Program (PAP), and other important stakeholders involved with supporting patient access to our client’s therapies.

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team.
• Partner with Sales Team, Marketing, HCP, 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, 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 patient benefit options, prior authorization requirements, and alternate funding/financial assistance programs.
• 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.
• Understand and monitor national and regional payer trends and changes.
• Work collaboratively with Managed Markets team to elevate potential payer issues.
• Operate in compliance with HIPAA within program guidelines.
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data.
• Ensure all SOPs are followed with consistency.
• Conduct miscellaneous tasks or projects as assigned.

Qualifications

• Associate's degree or higher in a related field or equivalent market experience
• 3+ years in Case Management Reimbursement Experience
• 3+ in the Pharma/Healthcare industry; working with Hubs, Payers, HCP or related area
• 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 benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
• Demonstrated ability to conduct field-based reimbursement support and education
• Experience with new product launches, reimbursement billing, coding, and appeals process.
• Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process.
• Strong presentation skills
• Travel is limited, but the job may require infrequent travel for meetings with key accounts and training.
• Valid Driver’s License for those where travel required
• Preferred candidate location within the Western U.S. region with the ability to travel throughout the assigned Mountain West and West Coast territory, including key accounts across California, Washington, Oregon, Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, Alaska, and Hawaii, as business needs require.