Field Reimbursement Manager - Remote (Great Planes/Great Lakes)

Valeris, Inc.; Missouri; Híbrido; USD 90 000 - 130 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental, and vision plans

Health Savings Account support

401(k) with matching

Paid Time Off and holidays

EAP services

Career advancement opportunities

Resumo da oferta

Valeris, Inc. is seeking a Field Reimbursement Manager to help patients access therapies by resolving payer issues and educating provider offices on billing and coding for our products.

The role spans multiple states including MO, with up to 10% travel. You will collaborate with sales, payer, and supply chain teams to optimize reimbursement workflows while ensuring HIPAA compliance and high-quality patient support.

Qualificações

• Associate's degree or higher in a related field or equivalent market experience 3+ 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.

Responsabilidades

• Solve complex patient access issues by working across the Hub and provider offices and communicating with client field team.
• Partner with Sales, Payer, Marketing, HCPs, and their Specialty Pharmacies to drive reimbursement support approaches.
• Educate HCP and Office Staff on Patient Support Programs and program policies.
• Onsite education of program business rules, payer coverage including review of miscellaneous J-codes and other reimbursement activities.
• Guide healthcare providers through the prior authorization and appeals process with required documentation.
• Manage daily activities that support patient access across relevant sites of care.
• Coordinate with patient support services representatives on patient cases and claim issues.
• Educate office staff on patient assistance and reimbursement tools; provide information on reimbursement topics.
• Conduct policy surveillance across regional payers to ensure coding, coverage, and payment.
• Assist providers with understanding local payer coverage and reimbursement trends through events.
• Lead sales training related to product reimbursement as appropriate.
• Communicate reimbursement concerns with Sales and Managed Markets.
• Understand and monitor national and regional payer trends and changes.
• Work with Managed Markets to avoid payer issues.
• Ensure SOPs and BRDs are followed with consistency and HIPAA compliance.

Conhecimentos

Associate degree or higher

Pharma/Healthcare experience

Payer policy knowledge

Prior Authorization experience

Education and training staff

Formação académica

Associate's degree or higher in a related field

3+ years in Pharma/Healthcare

Descrição da oferta de emprego

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: NE, KS, OK, TX, AR, MO, IA, IL, IN, MI, and OH and parts of KY.

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.

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 escape 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.

Qualifications

Associate's degree or higher in a related field or equivalent market experience 3+ 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.

Preferred Location

Preference will be given for candidates residing in the following states: Montana, Wyoming, Colorado. North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa Missouri Wisconsin, Michigan, Idaho, Utah, or Indiana.

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.

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?

We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:

• 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.

A Name With Purpose.

Inspired by those who work each day to transform access and enhance lives, our name emerges from the root valor: to be bold, brave, determined, be well, have worth. It speaks to integrity, simplicity, strength, and principled action.

Purpose:

Valeris represents measurable business impact through healthcare innovation that transforms lives. We combine cutting-edge technology with healthcare expertise to tackle challenges in access, affordability, and quality of care. Success means improving patient outcomes - everything we do is anchored in the value of improving human lives.

We honor the science. We unlock the value. We do it with vision. We are Valeris.