Field Reimbursement Manager II

The Fountain Group; Plainsboro Township (NJ); Remote; USD 80,000 - 120,000; Full time

Job summary

A leading company is seeking experienced Field Reimbursement Managers specializing in hemophilia therapy access. In this role, you will educate healthcare providers, manage reimbursement inquiries, and collaborate with internal teams to enhance patient outcomes. The position requires significant travel and a deep understanding of the pharmaceutical reimbursement landscape.

Qualifications

• 4 years of pharmaceutical sales or reimbursement experience, 2 years field reimbursement experience.
• Comprehensive knowledge of payer billing practices, drug reimbursement processes.
• Experience in pharmaceutical supply chain and implementation of patient access initiatives.

Responsibilities

• Serve as a point of contact for reimbursement inquiries.
• Monitor reimbursement trends and advise on healthcare policy changes.
• Educate healthcare professionals about reimbursement processes.

Skills

Communication

Analytical skills

Problem-solving

Interpersonal skills

Education

Bachelor's degree

Job description

Bill: $94.75
Pay: $64.90
Spread:587.1
MU:46%
Duration:1 year, potential to extend


LOCATION: Field position (remote) out of the Plainsboro office
• Field Based, East
• Field Based, West
DURATION: 1 year, potential to extend
MAX BILL RATE: up to $94.75
MARKUP: 46%

Job Title: Field Reimbursement Manager – Hemophilia

Physical Requirements: Ability to travel up to 75%

Job Summary: We are seeking experienced and passionate Field Reimbursement Managers to join our team,
specializing in hemophilia. This role will focus on ensuring access to our hemophilia therapies, educating healthcare professionals about reimbursement processes, and collaborating with internal teams to support our commitment to improving patient outcomes.

Key Responsibilities:
• Serve as a primary point of contact for healthcare providers and internal stakeholders regarding reimbursement-related inquiries for hemophilia therapies.
• Collaborate with provider offices and specialty pharmacies, and provider offices to facilitate reimbursement and establish productive working relationships.
• Monitor reimbursement trends and changes in healthcare policies that may impact access to hemophilia treatments, advising the organization as needed.
• Assist in building, tracking, and reporting on key performance indicators to monitor overall performance.
• Work closely with NovoCare to review benefits investigation and provide prior authorization and appeals support, as requested.
• Ensure compliance with reimbursement regulations and guidelines.
• Develop and maintain relationships with billing and coding staff, and develop a deep understanding of their business including patient demographics, payer landscape, regional payers, networks/affiliations, etc.
• Use approved tools, such as dashboards and coding guides to assist offices with a smooth and efficient patient journey towards therapy access.
• Gather and analyze data on reimbursement challenges and address them proactively through collaboration with cross-functional teams.
• Manage their own budget.
• Successfully manage other projects as directed with proven results.
Access Education
• Educate healthcare professionals and patient support teams about existing reimbursement processes, policies, and available financial assistance programs.
• Assist HCPs in understanding patients' insurance benefits, navigating financial assistance options, and overcoming access barriers.
• Provide training and resources to internal sales and marketing teams about reimbursement processes related to hemophilia therapies.
• Deliver approved leave-behind product educational materials to help inform relevant office personnel of reimbursement landscape/policies/criteria.
Communicate and Collaborate
• Collaborate with other field reimbursement managers to identify the best practices seen in different practice settings across the country.
• Quickly identify, communicate, and address outstanding reimbursement issues and trends, escalating to FRM leadership, Sales, Market Access, Marketing and others to help inform additional support and resource needs.
• Proactively communicate with the Market Access account team to gain a complete understanding of payer-specific coverage, medical and pharmacy policies, and utilization management criteria (i.e. Step Therapy, PA, etc.).
• Regularly interact with field matrix teams to identify, assess and address issues in assigned geography.
• Inform and support internal teams on the development of reimbursement related resources and tools for use by customers.

Required Qualifications:
• Bachelor's degree required, preferably in a science or business discipline.
• 4 years of relevant pharmaceutical sales or reimbursement experience with at least 2 years field reimbursement (pharmacy and buy-n-bill) experience.
• Comprehensive knowledge and understanding of payer billing practices in the US health care system, including Medicare, Commercial, Medicaid and other payer archetypes.
• Strong understanding of drug reimbursement processes and insurance policies.
• Experience in the manufacturing sector, particularly in understanding the supply chain and distribution processes for pharmaceutical products.
• Preferred experience in implementing patient access initiatives (i.e. hub programs).
• Preferred knowledge of hemophilia treatment landscape and related regulatory guidelines.
Skills Necessary for Success:
• Excellent communication and interpersonal skills to build relationships with healthcare providers and internal teams.
• Technical knowledge of health care reimbursement from a patient and provider perspective (authorizations, miscellaneous J codes, billing, coding, prior authorizations, appeals, patient and provider support programs and HUB operations).
• Strong analytical and problem-solving skills to proactively identify and resolve reimbursement issues.
• Firm understanding of HIPAA rules and regulations related to patient privacy.
• Ability to work independently and collaboratively within a fast-paced team environment.
• Proficient in utilizing reimbursement software tools and CRM systems to track interactions and outcomes.
• High level of empathy and commitment to patient advocacy.