Field Reimbursement Manager

Valeris; Phoenix (AZ); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

HSA- and FSA-eligible options

Telehealth and EAP services

401(k) with employer match

PTO and sick leave

9 paid holidays + 2 floating holidays

Career growth opportunities

Inclusive workplace culture

Job summary

Valeris is seeking a Field Reimbursement Manager (FRM) to help patients access therapies by educating healthcare providers on billing and reimbursement processes. The FRM will partner with sales, payer, and HUB teams to develop strategic reimbursement support for client products, and travel as needed to sites of care.

The role requires knowledge of prior authorizations, commercial payer policies, and medical benefit verification, with a focus on education and collaboration across multiple

Qualifications

• Associate's degree or higher in a related field or equivalent market experience.
• Experience with payer policy, prior authorizations, and reimbursement processes.
• Experience with virtual and field-based reimbursement support and education.
• Knowledge of Medicare/Medicaid structure, commercial payers, and reimbursement processes.
• Strong communication with HCP offices and clinic staff.

Responsibilities

• Resolve patient access issues and educate provider offices on billing and coding for client products.
• Educate HCP and office staff on patient support programs.
• Lead onsite education of program rules, payer coverage, and J-code reviews.
• Coordinate daily activities supporting patient access across HUB reimbursement services.
• Review billing and coding for products and assist with reimbursement issues.

Skills

Reimbursement knowledge

Prior authorizations

Payer policy knowledge

Education & training

HCP communications

Education

Associate's degree or higher

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 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. 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 escalation potential payer issues.

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

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

• working with specialty products, 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 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.

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. As part of our organization, full-time employees can expect:

• 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.