Field Reimbursement Manager

Celltrion USA, Inc.; New Jersey; On-site; USD 90,000 - 130,000; Full time

Job summary

Celltrion USA, Field Reimbursement Manager, reporting to the Director, Field Reimbursement, is responsible for the successful launch of Patient Access initiatives within the assigned territory. The role emphasizes leveraging strategic insights in targeted accounts to achieve reimbursement objectives and site-of-care support.

You will develop reimbursement strategies, stay current with CMS/payor policies, manage prior authorizations to appeals, review patient information for coverage challenges,

Qualifications

• 4-year college degree or equivalent experience.
• 3-5 years of medical benefit reimbursement experience.
• Minimum of 5 years of pharmaceutical reimbursement or related field experience.
• Immunology and/or Oncology experience a plus.

Responsibilities

• Provide live one-on-one reimbursement coverage support.
• Develop reimbursement strategies to ensure coverage and access.
• Understand CMS payers and site-of-care requirements for onboarding.
• Handle prior authorizations to appeals/denials procedures.
• Review patient-specific information for coverage challenges.
• Monitor payer policy changes and coordinate with internal teams to ensure coverage.

Skills

Relationship building

Managed care knowledge

Cross-functional collaboration

Training & conferences

Travel up to 50%

Remote work readiness

Education

Bachelor's degree in business/healthcare

Job description

Celltrion USA is Celltrion’s U.S. subsidiary established in 2018. Headquartered in New Jersey, Celltrion USA is committed to expanding access to biologics to improve care for U.S. patients. Celltrion USA will continue to leverage Celltrion’s unique heritage in biotechnology, supply chain excellence, and best-in-class sales capabilities to improve access to high-quality biopharmaceuticals for U.S. patients. Celltrion Healthcare, which suggested a new growth model in the Korean biopharmaceutical industry through biosimilars, is now advancing to new challenges to become a global pharmaceutical provider. Just as it has overcome many obstacles in the past, Celltrion Healthcare will successfully pave the path for global direct selling, which has never been achieved yet by Korean biopharmaceutical companies. As it continues to surpass its current success, Celltrion Healthcare will take a leap forward to become a leading global biopharmaceutical company.

Celltrion Healthcare provides biosimilar and innovative biopharmaceutical medications to help increase patient access to advanced therapies around the world.

POSITION SUMMARY

Celltrion USA, Field Reimbursement Manager, reporting to the Director, Field Reimbursement. The Field Reimbursement Manager is responsible for the successful launch of Patient Access initiatives of our client within the assigned geographic territory. The primary focus of the Field Reimbursement manager is to leverage strategic insights within targeted accounts to achieve identified business objectives including reimbursement support and site of care

assistance.

KEY ROLES AND RESPONSIBILITIES

• Act as an extension of the client company providing live one-on-one coverage support.
• Develop and implement reimbursement strategies to ensure appropriate coverage and access to our products.
• Familiarity with medical policy for insurance payers. Strong understanding of Centers for Medicare and Medicaid (CMS) and final-rules and methodologies, experience with multiple places of service requirements, comprehension of Commercial Insurers (Aetna, Anthem Blue Cross Blue Shield, Cigna, Humana, United Health Care) is needed to onboard efficiently and succeed in this role.
• Offer customer assistance throughout the entire Reimbursement journey. Includes prior authorization to appeals/denials requirements procedures and forms.
• Reviewing patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges.
• Monitor payer policy changes and work with internal teams to ensure our products are covered.
• Analyze reimbursement trends and develop strategies to address issues or improve access to our products.
• Identifying alternate funding/financial assistance programs.
• Coordinating with patient support services programs representatives.

WORK EXPERIENCE

• 4-year college degree (preferably in a healthcare-related field) or equivalent experience.
• 3-5 years of previous (buy and bill) medical benefit reimbursement experience required.
• Minimum of 5 years of experience in pharmaceutical reimbursement, managed care, or related field.
• Immunology and/or Oncology experience a plus.

SKILLS AND SPECIFICATIONS

• Proven experience building, maintaining, and leveraging relationships.
• Advanced Managed Care Organization/Accountable Care Organizations/Patient Centered Medical Homes knowledge.
• Advanced skills in resource collaboration with Marketing and Sales Teams.
• Ability to attend required training programs as well as periodic scientific conferences.
• Willingness to travel to customer meetings, internal meetings, and symposia, up to 50% of the time.
• This is a field-based role but much of the time will be spent working remotely

EDUCATION

• Bachelor's degree in business, healthcare, or related field

CORE COMPETENCIES

• Communication and interpersonal skill
• Quality and Quantity of work

Celltrion USA is an equal opportunity employer. It is our policy to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment because of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information, gender identity or expression, sexual orientation, marital status, status as a protected veteran, or any other legally protected group status.