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

Valeris; United States; A distancia; USD 90.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision plans

401(k) with match

PTO and paid holidays

Volunteer time off

Career development opportunities

Descripción de la vacante

Valeris is seeking a Field Reimbursement Manager to help eliminate barriers for patients and increase access to medications. You will educate provider offices on billing and coding, work with HUB, Copay Card and PAP vendors, and serve as the reimbursement SME across sites of care.

Travel up to 10% and collaboration with Sales, Managed Markets, and other teams are expected. The role requires 3+ years in Pharma/Healthcare and experience with prior authorizations, billing, coding, and appeals.

Formación

• 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.
• 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.

Responsabilidades

• Resolve patient access issues by coordinating with HUB, provider offices and client field team.
• Educate office staff on patient support programs and reimbursement topics.
• Lead onsite staff education on program rules, payer coverage, J-codes and related activities.
• Guide providers through prior authorization and appeals, assisting with documentation and payer requirements.
• Monitor payer trends and communicate reimbursement concerns with internal stakeholders.

Conocimientos

Stakeholder engagement

Communication skills

Virtual and field-based support

Educación

Associate’s degree or higher

Descripción del empleo

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 helpeliminatebarriers 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 onappropriate billingand coding forclient’sproducts, and provide educational services within relevant sites of care. Additionally, the FRM role will work directly with office support staff,billingand coding staff, applicable third-party vendors(HUB, Copay Card, Patient Assistance Program (PAP)),and other important stakeholders involved with supportingpatientaccess 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

• Solvecomplex patient access issues by working across the Hub, provider offices and communicating withclientfield team.
• Partner withclient’sSalesTeam, Payer Teams,Marketing,HCPs,andtheirSpecialty Pharmaciesto 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 coverageincluding review of miscellaneous J-codes, and other reimbursement related activities.
• Guide healthcare providers through the prior authorization and appeals process,assistingwith required documentation, payer-specific requirements, and outcome communication.
• The FRM will manage daily activities that supportappropriate patientaccess to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
• Reviewappropriate billingand coding for products,assistwith resolving reimbursement issues, and help ensureappropriate educationto 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 patientassistanceand 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 ensureappropriate coding, coverage, and payment ofclient’sproducts.
• Assistproviders with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, asappropriate.
• Communicate reimbursement concerns and issues withappropriate internalstakeholders, including Sales and Managed Markets.
• Understand andmonitornational and regional payer trends and changes.
• Work collaboratively withManagedMarkets team to escrow 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 SOPsand BRDsarefollowed 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,HCPor 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 ofmedicalbenefit 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 commercialpayer, Medicare and Medicaid structure, systems, and reimbursementprocess.
• Strong stakeholder engagement and communication skills

Travel Requirements :

• Job mayrequireup to10% travel
• Additionaltravel will berequiredforvarious national meetings, training programsand POAs
• Valid Driver’s License for whentravelis 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, or Indiana

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.