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

Mercalis; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Valeris, a life sciences commercialization partner, seeks a Field Reimbursement Manager to reduce barriers to patient access by guiding billing, coding, and reimbursement for client therapies across care sites.

You will educate provider offices, coordinate with HUB, copay vendors, and manage prior authorizations and appeals while collaborating with Sales, Managed Markets and stakeholders.

Travel up to 10% is common; role is field-based with ongoing education and cross-functional collaboration.

Qualifications

• Associate's degree or higher in a related field or equivalent market experience.
• 3+ years in Pharma/Healthcare with specialty products, hubs, payers, 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 with Hub, provider offices and client field team.
• Partner with client’s Sales Team, Payer Teams, Marketing, HCPs, and their Specialty Pharmacies to drive reimbursement support.
• Educate HCP and Office Staff on Patient Support Programs and policy operating guidelines.
• On occasion, lead HCP offices in onsite education of program business rules and payer coverage.
• Guide providers through prior authorization and appeals process with required documentation.
• Manage daily activities to support patient access across sites of care as an extension of HUB services.
• Review billing and coding for products, resolve reimbursement issues, and educate to avoid future hurdles.
• Coordinate with patient support representatives on cases and claim issues.
• Educate staff on client’s patient assistance and reimbursement tools and topics.
• Conduct policy surveillance across regional payers for coding, coverage and payment.
• Assist providers with understanding local payers and reimbursement trends via events.
• Lead sales training related to product reimbursement as appropriate.
• Communicate reimbursement concerns with Sales and Managed Markets.
• Monitor national and regional payer trends and work with Managed Markets on issues.
• Operate in compliance with HIPAA and training deadlines; follow SOPs and BRDs.

Education

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

Job description

Valeris is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Valeris helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

Valeris fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient‑centric solutions that eliminate barriers for patients, and increase patient access to life altering medications.

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 elevate 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+ 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.
• 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.
• 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, Indiana.