Field Reimbursement Manager, Retina (Northwest)

Thea Pharma US; Seattle, Denver (WA, CO); On-site; USD 200,000 - 230,000; Full time

Benefits offered by this job

Health benefits

401(k)

Paid time off

Job summary

Thea Pharma Inc. is seeking a Field Reimbursement Manager – Retina to drive access and coverage for our retina portfolio across high-volume practices.

You will lead pre-launch readiness, educate billing staff, and troubleshoot complex claims while partnering with internal teams to ensure a seamless launch. Ideal candidates have 6+ years in medical reimbursement, ophthalmology/retina experience, and deep knowledge of Part B/D, ASP, and payer policies.

Qualifications

• Bachelor's degree required; an advanced degree or coding certification is a plus.

Responsibilities

• Pre-Launch Account Readiness: Conduct intensive pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices.
• J-Code Tracing: Educate practices on proper claims submission using new J-Codes and transition once ASP is established.
• Tracking First-Claim Success: Monitor initial claims submissions to identify payer rejections and formatting errors.
• Strategic Account Support: Serve as the subject matter expert on reimbursement and access for complex retina practices, ASCs, and hospital outpatient departments.
• Provider Education: Educate clinic staff and billing personnel on payer policies, prior authorizations, and coding.
• Reimbursement Troubleshooting: Analyze and resolve complex reimbursement issues and denials.
• Buy-and-Bill & Specialty Pharmacy Expertise: Guide practices on buy-and-bill operations and patient assistance programs.
• Local Payer Policy Tracking: Track local commercial and Managed Medicaid policy determinations for the product.
• Hub Coordination: Train staff on using the Patient Support Hub for benefits verification and prior authorization support.
• Cross-Functional Collaboration: Partner with Field Sales, Key Account Managers, and Patient Support Services.
• Travel requirement: Approximately 50% travel.

Skills

Presentation skills

Problem solving

Team collaboration

Microsoft Office

CRM platforms

Education

Bachelor’s degree

Coding certification / advanced degree

Tools

Microsoft Office

CRM platforms

Job description

Territory: Northwest (Seattle, Northern CA, Denver)

COMPANY:

Thea Pharma Inc. is the newly established US commercial organization of French-based pharmaceutical company, Laboratoires Théa (Clermont-Ferrand). Thea Pharma markets a suite of leading eye-care drugs that have been approved by the U.S. Food and Drug Administration (FDA), including CYKLX™, ZOLYMBUS™, IYUZEH™,Zioptan®,Cosopt®,Cosopt® PF,Azasite®,Akten®, andBetimol®, as well asAcellFX™ Acellular Amniotic Membrane and the portfolio of iVIZIA dry-eye drops and eyelid hygiene products. By focusing its parent company’s passion andexpertisewithin the U.S. market, Thea Pharma’s goal is to deliver uncompromising care that enables all stakeholders to envision the future of ophthalmic treatment with eyes wide open.

SUMMARY:

The Field Reimbursement Manager (FRM) – Retina is a field-based specialist responsible for addressing access, reimbursement, and coverage barriers for our retina portfolio. You will serve as the primary strategic expert for retina practices, ophthalmologists, and billing staff—helping them navigate complex insurance processes, prior authorizations, appeals, and "buy-and-bill" procedures.

As a launch-focused FRM, you will be instrumental in executing the market access readiness strategy for our newly launched retina therapy. You will proactively prepare accounts for launch, accelerating the time-to-treatment by mitigating initial billing uncertainties, helping practices secure early coverage, and instilling confidence in our reimbursement processes. This role does not involve commercial sales or promoting the clinical benefits of the drug. You will partner with your internal Matrix team to ensure that practices are prepared and comfortable with Thea and our new products.

Partner withCompliance, Finance, Distribution, and Training to ensure coordinated customer engagement and successful execution of reimbursement strategies. This role reports to theDirectorofRetinaField Reimbursement.

KEY RESPONSIBILITIES:

• Pre-Launch Account Readiness: Conduct intensive pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices to minimize administrative delays.
• J-Code Tracing: Educate practices on how to properlysubmitclaims using new permanent J-Code HCPCS codes without an established ASP andleadthe smooth operational transition once the ASP isestablished.
• Tracking "First-Claim" Success: Closelymonitorinitial claims submissions for early-adopting practices toidentifyandimmediatelytroubleshoot systemic payer rejections or clearinghouse formatting errors.
• Strategic Account Support: Serve as the subject matter expert on reimbursement, coverage, and access for complex retina practices, ASCs (Ambulatory Surgery Centers), and hospital outpatient departments.
• Provider Education: Educate clinic staff, specialized billing personnel, and practice managers on local/national payer policies, prior authorization requirements, claims submission processes, and specific coding (J-codes, CPT codes, ICD-10).
• Reimbursement Troubleshooting: Analyze and help resolve complex reimbursement issues, including denied claims, underpayments, and complex appeals, byprovidingcompliant guidance.
• Buy-and-Bill & Specialty Pharmacy Expertise:Guidepractices on the operational mechanics of the buy-and-bill model, specialty pharmacy fulfillment, inventory management, and utilizing co-pay or patientassistanceprograms.
• Local Payer Policy Tracking: Actively track and map the rollout of local commercial and Managed Medicaid policy determinations for the new product, relaying real-time market updates back to internal launch teams.
• Hub Coordination: Ensure clinic staff are fully trained on how toutilizethe new product's Patient Support Program (Hub) for rapid benefits verification and prior authorization support.
• Cross-Functional Collaboration: Partner compliantly with Field Sales, Key Account Managers, and internal Patient Support Services (Hubs) to ensure a seamless access experience for provider offices.

QUALIFICATIONS:

• Launch Experience: 2+ years of direct experience executing buy-and-bill product launches in the specialty biologic or pipeline space (Ophthalmology/Retina launch experience heavily preferred).
• Therapeutic Expertise: Prior experience in Ophthalmology/Retina is highly preferred due to the unique, high-volume workflow of retina clinics.
• Technical Knowledge: Deep understanding of Medicare Part B (including Average Sales Price / ASP models), Medicare Part D, commercial insurance, Medicaid, and specialized Hub reimbursement services.
• Agility & Ambiguity Management:Demonstratedability to navigate the fluid, fast-paced environment of a product launch, where payer policies are evolving daily.
• Skills: Exceptional presentation skills and the ability to explain complex financial/billing rules in simple terms. Strong problem-solving skills for resolving rejected claims.
• Compliance: Strict adherence to healthcare compliance regulations, including HIPAA, OIG guidance, and individual company compliance policies.
• Demonstrated success partnering in a matrixed environment.
• Systems & Software: Extensiveproficiencywith Microsoft Office (Word, Excel, PowerPoint, Teams, Outlook) and CRM platforms.
• Travel requirement: Approximately 50%, including overnight travel.

EDUCATION AND EXPERIENCE:

• Bachelor’s degreerequired; an advanced degree or coding certification (e.g., CPC, CHC, PACs) is a plus.
• Experience: 6+ years of experience in the pharmaceutical/biotech industry, specifically in medical reimbursement, patient access, or field reimbursement.
• 6+years experiencesupporting buy-and-bill products required in ophthalmology, rare disease, or specialty pharmaceuticals preferred.

PHYSICAL DEMANDS & WORK ENVIRONMENT

This position requires prolonged sitting. Additionally, requireseye-hand coordination and manualdexterity enoughtooperatea keyboard, photocopier, telephone, and other office equipment. Requiresnormalrange of hearing and vision to record, prepare, and communicate appropriately.Additionalphysical requirements include hearing spoken communication clearly.

BENEFITS AND PERKS

Thea offers a full suite of employee benefits, including employer-paid medical, dental, and vision insurance; a generous schedule of paid time off (PTO); life and disability insurance; paid parental leave; and a competitive 401(k) company match. Thea is a flexible and entrepreneurial work environment where you will enjoy an inclusive culture and the opportunity to have your voice and ideas directly shape the future of the company.

For U.S. locations that require disclosure of compensation, the starting pay for this role is between $200k to $230k. The estimated salary range reflectsan anticipatedrange for this position. The actual base salary offered may depend on a variety of factors.

EEO STATEMENT

Thea Pharma Inc. is proud to be an Equal Employment Opportunity employer. At Thea, we not only support the diversity of our employeepopulation,wecelebrate the way our team member’s unique backgrounds and experiences contribute to the success of our company. Thea does not discriminate on the basis of race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Thea Pharma Inc. does not tolerate harassment or discrimination of any kind.

ADDITIONAL INFORMATION

Your information will be kept confidential according to EEO Guidelines.