Field Reimbursement Manager — Access & Prior Authorization

Valeris; New Mexico; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Paid holidays

Life insurance

Job summary

Valeris is seeking an experienced Field Reimbursement Manager to join our team. This field-based role focuses on eliminating patient access barriers by educating providers on billing and coding for our products and by supporting prior authorization and appeals processes.

You will collaborate with Sales, Payer, and HCP teams, visit sites of care, and provide education on patient support and reimbursement programs. Travel up to 10% is required.

Qualifications

• Associate degree or higher in a related field or equivalent market experience.
• 3+ years in Pharma/Healthcare industry; working with specialty products, hubs, payers, HCP or related area
• 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

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, 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 escalation 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

Skills

Reimbursement expertise

Stakeholder engagement

Healthcare industry experience

Virtual and field support

Payer policy knowledge

Education

Associate's degree or higher

Tools

HUB systems

Billing software

Coding databases

Job description

Valeris is seeking an experienced Field Reimbursement Manager to join our team. This field-based role focuses on eliminating patient access barriers by educating providers on billing and coding for our products and by supporting prior authorization and appeals processes.

You will collaborate with Sales, Payer, and HCP teams, visit sites of care, and provide education on patient support and reimbursement programs. Travel up to 10% is required.