Field Reimbursement Manager

Recordati; Sacramento (CA); Remote; USD 90,000 - 130,000; Full time

Job summary

Recordati Rare Diseases, Inc. (RRD) seeks a Field Reimbursement Specialist to support payor policy, coverage decisions, and access for our rare disease therapies in the U.S. This remote role requires strong collaboration with care teams, prior authorization guidance, and education for HCP offices.

It involves travel 30-40% and working within a compliant, ethical framework. You will partner with cross-functional teams to develop account plans and analyze payer trends while maintaining high

Qualifications

• Bachelor’s degree in healthcare or related field is required.
• Experience in field-based role working with provider offices and/or patient support HUB services.
• Minimum of five to seven years in healthcare/pharma industry.
• Minimum of three years field reimbursement experience.
• Minimum of two years working with buy and bill and/or specialty pharmacy networks.
• Ability to analyze and interpret regulations and legislation regarding coding, coverage and reimbursements.
• Experience with reimbursement processes (buy-and-bill, prior authorization, coding, and appeals).
• Strong problem-solving and communication skills, with ability to present to healthcare staff.

Responsibilities

• Partner with cross-functional teams on territory strategy to enhance payer knowledge and access.
• Serve as a subject matter expert on coverage, access and reimbursement for company therapies.
• Coordinate with HCP staff and Specialty Pharmacy on prior authorizations or appeals.
• Act as reimbursement expert for regional access landscape including payer policies and denials.
• Collaborate on case management needs related to HCP education on reimbursement issues.
• Collect field insights on payer trends to inform internal stakeholders.
• Develop and execute account plans using internal data and resources.
• Maintain compliance with laws, regulations and the company code of ethics.

Skills

Relationship building

Communication skills

Planning & organizing

Microsoft Office

Travel readiness

Ethical standards

Education

Bachelor’s degree

Job description

This position is with Recordati Rare Diseases, Inc. (RRD), North America, an affiliate of Recordati. Recordati Rare Diseases, Inc. (RRD) develops high-impact therapies for devastating rare diseases, focusing on providing often overlooked treatments to underserved communities in the U.S. Our mission is to mitigate the impact of rare diseases through increased awareness, improved diagnoses, and enhanced treatment availability, covering endocrinology, metabolic, and oncology franchises. RRD is dedicated to excellence, fostering a dynamic work environment that promotes professional growth and a significant impact on patients' lives.

Reporting Structure

Reports To: Associate Director, Field ReimbursemenetDirect Reports: NoneAreas Managed: Field ReimbursementOverview

Key Responsibilities

• Partnering with cross-functional parties on overall account and territory strategy to maximizeinternal/external customer knowledge on payor policy and processes
• Serve as subject matter experts on issues of coverage, access and reimbursement by providingcompliant, limited support to US health care providers (HCPs) and their office staff in navigating the reimbursement landscape for products of Recordati Rare Diseases Inc. (RRD) after the HCP made an independent decision to prescribe
• Collaborate with HCP staff and Specialty Pharmacy to follow up with accounts that have outstanding prior authorization or appeals submissions
• Being a subject matter expert on reimbursement and regional-specific access landscape. This includes payor policies, prior authorization requirements, denials, appeals, peer to peer and other education required to navigate access for coverage of company therapies
• Collaborating with cross-functional parties on individual case management needs related to HCP education on reimbursement issues
• Collect field insights on payer trends, reimbursement challenges and provider needs to inform internal stakeholders
• Leveraging all available resources including internal data to develop and execute account plans/call purpose
• Complying with all laws, regulations and policies that govern the conduct of company activities, work with the highest degree of professionalism and in accordance with the company’s code of Ethics and Business Conduct
• Complying with annual budget allocation within respective territory to Perform additional duties as may be assignedEducation and Experience

Education and Experience

• Bachelor’s degree
• Experience in working in field-based role working with provider offices and/or with patient support HUB services
• Minimum of five to seven years of experience in the healthcare and/or pharmaceutical industry
• Minimum of three years successful field reimbursement experience
• Minimum of two years of experience working with buy and bill and/or specialty pharmacy networks
• Ability to analyze and interpret regulations and legislation regarding coding, coverage and reimbursements In-depth knowledge of the U.S. pharmaceutical market, specifically rare diseases.
• Reimbursement or relevant managed care experience (buy-and-bill, prior authorization, coding, and appeals processes)
• Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner
• Comfortable presenting in person or virtual to Healthcare practitioner office staff
• Superior communication skills (written and verbal) and efficient follow-through

Knowledge and Skills

• Strong relationship-building skills, with demonstrated ability to collaborate and operate acrossfunctions
• Strong planning and organizational skills; demonstrated decision-making ability Reliable transportation within territory
• Proficiency in Microsoft Office
• Demonstrated highest ethical standards
• Demonstrated effective problem-solving and decision-making capabilities
• Ability to prioritize/multi-task effectively
• Excellent verbal and written communication skills

Work Environment

This job operates in a professional remote environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Based upon job requirements, the employee is required at times to travel to HCP offices offices within a specified territory and attend meetings including travel out of state over weekends and nights. The employee must be able to freely operate and travel by car and train/plane modes of transportation. The employee is required to have a valid driver’s license and means of transportation.

Physical Demands

The physical demands described here are representative of those required to successfully perform the essential functions of this position. The employee must be able to travel domestically and internationally, as business needs require. This position is primarily sedentary. The employee may occasionally move throughout office, meeting, or event locations and regularly operate a computer, telephone, and other office productivity equipment. The employee must be able to communicate effectively with internal and external stakeholders. Occasionally, the employee may be required to move or transport items weighing up to 25 pounds, with or without accommodations.

Location/Travel

This position is a remote position with proximity to a major airport This position requires approximately 30-40% travel (need based).

FLSA Classification

This position is considered Exempt.

EEO Statement

It is the policy of Recordati Rare Diseases to provide equal employment opportunity (EEO) to all persons regardless of race, color, religion, sex, sexual orientation, gender identity, or national origin. Further, Recordati Rare Diseases will not discriminate on the basis of any characteristic protected by federal, state, or local law. Recordati Rare Diseases will provide reasonable accommodations for a qualified individual with disabilities.

Disclaimer

This job description is not designed to cover or contain a comprehensive listing of the activities, duties or responsibilities that may be required