Field Reimbursement Manager (FRM) - Mid Atlantic

Otsuka Pharmaceutical Co., Ltd; Northern (KY); Hybrid; USD 135,000 - 201,000; Full time

Benefits offered by this job

Comprehensive medical, dental, vision,

Prescription drug coverage

Tuition reimbursement

401(k) match

Flexible time off

Paid holidays and leave programs

Job summary

Otsuka Pharmaceutical Co., Ltd. is seeking a Field Reimbursement Manager to serve as the subject-matter expert on reimbursement, access, and coverage issues for Nephrology and Rare Disease products.

The role acts as a liaison among HCPs, internal teams, and external stakeholders to facilitate patient access. The FRM will educate offices on payer policies, analyze criteria, coordinate with hubs, and collaborate with Field Sales and other partners while spending 60-70% of time engaging with care

Qualifications

• Bachelor's degree required.
• 5+ years of pharmaceutical industry experience focusing on payer policy and reimbursement.
• 3+ years in benefit verifications, prior-authorization, or equivalent patient access/billing in rare disease.

Responsibilities

• Educate HCPs and staff on access, coverage, reimbursement processes, claims submissions, and coding requirements.
• Analyze payer criteria and provide product access expertise to healthcare offices.
• Coordinate with hubs on patient cases, including enrollment and support services.
• Collaborate with Field Sales, Specialty Pharmacy Accounts and matrix partners.
• Manage daily field activities, spending 60-70% with key stakeholders across care sites.
• Execute territory plans through internal and external partnerships.
• Review and educate offices on payer policies, including prior authorization requirements.
• Provide feedback on local payer trends and access issues.
• Assist in resolving patient-specific coverage challenges when requested by providers.

Skills

Communication

Interpersonal skills

Organizational skills

Relationship building

Training & presentations

Education

Bachelor's degree

Tools

MS Office

Job description

Position Summary

The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and Rare Disease. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.

Key Responsibilities

• Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements


• Analyze payer criteria and provide product access expertise to healthcare offices


• Coordinate with Hubs on individual patient cases, including patient support services and enrollment


• Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners


• Manage daily field-based activities, spending 60-70% of time interacting with key stakeholders across various care sites


• Execute collaborative territory plans through partnerships with internal and external stakeholders


• Review and educate offices on payer policies, including prior authorization requirements


• Provide feedback to internal teams on local payer trends and access issues


• Assist in resolving patient-specific coverage challenges when requested by healthcare providers

Skills and Abilities

• Excellent verbal and written communication skills


• Strong interpersonal and consultative abilities


• Self-directed with outstanding organizational skills


• Ability to build and maintain strong relationships with internal and external customers


• Proficient in delivering training and presentations

Qualifications Required

• Bachelor's degree


• 5+ years of pharmaceutical industry experience, with focus on payer policy and reimbursement


• 3+ years of experience in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease

Preferred

• Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D


• Experience in \"Buy and Bill\" reimbursement environment


• Nephrology experience strongly preferred


• Comprehensive understanding of US healthcare system payer billing practices


• Proficiency in MS Office suite

Competencies

• Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.


• Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business.


• Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.


• Impactful Communication - Communicate with logic, clarity, and respect.


• Influence at all levels to achieve the best results for Otsuka.


• Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals.


• Empowered Development - Play an active role in professional development as a business imperative.

Travel

• Ability to travel up to 60-70% domestically


• Valid driver's license required

Salary

Minimum $134,615.00 - Maximum $201,250.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate’s job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws.

Application Deadline

This will be posted for a minimum of 5 business days.

Company Benefits

• Comprehensive medical, dental, vision, prescription drug coverage


• Company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance


• Tuition reimbursement, student loan assistance


• A generous 401(k) match


• Flexible time off


• Paid holidays, and paid leave programs as well as other company provided benefits

Equal Opportunity

Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting [e-mail].

Company Culture

Otsuka Pharmaceutical Co., Ltd. is a global healthcare company with the corporate philosophy: “Otsuka–people creating new products for better health worldwide.” In the U.S., Otsuka is comprised of two companies, Otsuka America Pharmaceutical, Inc., and Otsuka Pharmaceutical Development & Commercialization, Inc., that share a deep commitment to the development and commercialization of innovative products in the spaces of neuroscience, nephrology, and digital medicine. Driven by our purpose to defy limitation, so that others can too, we have an unwavering belief in doing more and transcending expectations. In going above and beyond—under any circumstances—for patients, families, providers, and for each other. It’s this deep-rooted dedication that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible each and every day. OPDC and OAPI are indirect subsidiaries of Otsuka Pharmaceutical Company, Ltd., which is a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan. The Otsuka group of companies employed 34,400 people worldwide and had consolidated sales of approximately USD 14.2 billion in 2023. We invite you to explore our open positions for an opportunity to join our 2,200 colleagues in the U.S. whose passion for our mission and pride in our company have earned us certification as a Great Place to Work by the Great Place to Work Institute.