Field Reimbursement Manager (New England)

The Lockwood Group®; Hartford (CT); On-site; USD 85,000 - 120,000; Full time

Job summary

The Stratis Group is seeking an experienced Field Reimbursement Manager (FRM) to manage a dedicated territory and support access for providers and patients in the cardiovascular space.

You will educate primary care and specialty providers on access services, reimbursement solutions, and payer landscape, while collaborating with sales, market access and cross-functional teams to execute strategic plans and ensure compliant outreach.

Qualifications

• 3+ years in Managed Care, Field Reimbursement, Patient Services, or related sales.
• 4-year degree in related field or equivalent experience.
• Cardiovascular experience a plus.
• Willing to travel 3–4 days per week within territory.
• Knowledge of CMS policies and Medicare Part D familiarity.

Responsibilities

• Manage daily activities to support appropriate patient access in provider offices and liaise with patient assistance and access services.
• Educate on Retail Pharmacy/ Specialty Pharmacy prior authorizations, appeals, and denials.
• Provide in-person customer visits and participate in client meetings.
• Input call activity into CRM and participate in cross-functional meetings and calls.
• Serve as payer expert for defined geography and communicate payer changes to stakeholders.
• Provide office education on access processes, including formulary criteria, coding, forms, benefits investigation, prior authorization, appeal, and claims resolution.
• Educate offices using approved educational materials provided by the client.

Skills

Managed Care experience

Field Reimbursement experience

Patient Services experience

Sales experience

CMS knowledge

Travel willingness

Driver's License

Education

4-year degree in related field or equivalent experience

Job description

About Stratis Group

Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand's lifecycle, our core passions include: market access, patient services, field reimbursement, and data-driven analytics.

Summary

In this contracted role, the Field Reimbursement Manager (FRM) is a client-facing and client-customer-facing role that will be responsible for managing a dedicated territory to support access for provider and patients. This role will be highly visible within the organization and responsible for providing education to primary care and cardiology specific healthcare providers and office staff on access services and reimbursement solutions specific to a product and therapeutic area (Cardiovascular).

The FRM will execute a region or territory strategic plan through partnership with internal and external stakeholders, which may include sales, market access, and/or other matrix field partners. Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. The FRM may also have to work on patient-level reimbursement issues without access to PHI. The FRM will abide in a compliant manner and will work closely within a defined set Rules of Engagement.

In this role, the FRM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The FRM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.

Additional responsibilities include

• Manage daily activities that support appropriate patient access to our client's products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
• Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
• Provide in-person customer visits.
• Participate in client meetings as appropriate. Participate in regularly scheduled internal team and cross-functional meetings and calls. Input call activity into customer CRM, as appropriate.
• Serve as payer expert for defined geography and able to communicate payer changes to key stakeholders in a timely manner.
• Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
• Educate offices using approved educational materials provided by the client.

Desired Job Requirements

• 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
• 4-year degree in related field or equivalent experience
• Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
• The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
• Solution oriented mindset, strong business acumen, & strong analytic capabilities
• Experience and understanding of Retail Pharmacies & Specialty Pharmacies
• Demonstrated ability to educate offices on access processes and issue resolution
• Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
• Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
• Advanced knowledge of medical insurance terminology
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
• Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
• Ability to manage ambiguity & problem solve
• Prepare and submit appropriate expense reports in a timely fashion
• Valid Driver's License