Field Reimbursement Manager

Valeris; Springfield (IL); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health, dental, vision plans

HSA/FSA options

401(k) company match

Paid time off and holidays

Background checks & drug screen

Job summary

Valeris seeks an experienced Field Reimbursement Manager to help patients access therapies by resolving reimbursement barriers and educating provider offices on billing and coding. You will collaborate with HUB, payer, and sales teams to drive access strategies and manage prior authorizations across multiple sites of care.

You will act as the reimbursement SME, coordinating with HUB and patient support programs, reviewing coding requirements, and guiding providers through documentation and

Qualifications

• Direct experience with specialty dermatology products.
• Must have specific practice management, billing and/or coding experience.
• 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.
• Strong stakeholder engagement and communication skills.

Responsibilities

• 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.
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
• Lead HCP offices in onsite education of program business rules, payer coverage including review of J-codes, and other reimbursement related activities.
• Guide healthcare providers through the prior authorization and appeals process, assisting with required documentation, payer-specific requirements, and outcome communication.
• Manage daily activities that support patient access to client’s products across sites of care as an extension of HUB reimbursement services.
• Review billing and coding for products, assist with resolving reimbursement issues, and educate to avoid future hurdles.
• Coordinate with client’s patient support services representatives on patient cases and claim issues.
• Educate office staff on client’s patient assistance and reimbursement tools and topics.

Skills

Field reimbursement

Payer policy knowledge

Dermatology products

Stakeholder engagement

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. To learn more about Valeris, please visit www.valeris.com. This position can be based in any of the following locations: VT, NY, NJ, PA, WV, OH, Southern IN & IL

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.

Responsibilitie

• sSolve 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.
• Guide healthcare providers through the prior authorization and appeals process, assisting with required documentation, payer-specific requirements, and outcome communication.
• 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.
• 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 and BRDs are followed with consistency

Preferred:

• Direct experience with specialty dermatology products
• 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.
• Strong stakeholder engagement and communication skills

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

Preferred Location:

Preference will be given for candidates residing in the following states: Vermont, New York, New Jersey, Pennsylvania, West Virginia, Ohio, Southern Indiana & Illinois

Physical Demands & Work Environment

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.

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.

Why Work for Valeris?

• 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
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
• 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
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission-driven, inclusive culture where your work makes a meaningful impact

Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.

Our Commitment to Equal Opportunity

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. Valeris is proud to be an equal opportunity employer.