Field Reimbursement Manager, San Diego, CA - Market Access

SUN PHARMA; California (MO); On-site; USD 145,000 - 175,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

401(k) savings plan

Paid time off

Job summary

Sun Pharma is seeking a Field Reimbursement Manager to support patient access for our branded products in the United States. You will educate practices, accounts, and providers on reimbursement, coding, and payment processes, while collaborating with field teams to resolve access issues and optimize payer relationships.

The role requires 5+ years in healthcare, strong knowledge of Medicare/Medicaid and commercial payers, and excellent communication and analytical skills to influence outcomes

Qualifications

• Bachelor’s degree required.
• 5+ years in healthcare with access/reimbursement experience.
• Experience with Medicare/Tricare/Medicaid and payer policies.

Responsibilities

• Inform field teams on local reimbursement, coding, and policy changes.
• Develop relations with payers and advocacy groups to improve access.
• Collaborate with field partners to resolve access issues in physician offices.
• Prepare reports for management on access strategy and outcomes.
• Represent Sun at National/local meetings and training sessions.
• Ensure compliance with Healthcare Compliance guidelines.

Skills

Communication skills

Presentation skills

Analytical skills

Teamwork

Education

Bachelor's Degree

Job description

The Field Reimbursement Manager is part of the Market Access group supporting Sun’s family of branded products in the United States. This primary goal of this role is to support appropriate patient access to care. This team focuses their efforts on supporting practices, accounts, and providers with necessary support materials and education to seek coverage to therapy for appropriate patients. Educational components include reimbursement (coverage, coding & payment), specialty pharmacy and distribution processes, provider support services (e.g., benefits investigation) and patient support resources (e.g., copay assistance programs, patient assistance programs) The person in this role will monitor national and local healthcare payer policies, develop relationships with key advocacy leaders, state societies, and provide direct support to prescribing physicians, hospitals and support staff regarding reimbursement and product access and reimbursement dynamic within payer channels.

The Field Reimbursement Manager will execute local market plans to support field based priorities. This will include understanding and educating on local health policy, reimbursement, billing / coding, and patient access issues. Field Reimbursement Managers will collaborate with his / her field partners to alleviate reimbursement and access issues impacting physician offices and the ability of patients to access Sun portfolio of products. The Field Reimbursement Manager will interact with access services hub, managed markets team supporting patient access and local field sales teams. The person in this role with have expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals, exceptions, denials, coding and payer payment guidelines , payer policies, sites of care, understanding of coding guidelines (CPT/J-Code/ICD-10), statutory or commercial pricing structures or mandates, and quality programs related to value based care and clinical care pathways.

Responsibilities Include

• Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access to the portfolio of Sun products.
• Has a deep understanding of medical vs pharmacy benefit and policy
• Understands the dynamics of Specialty pharmacy and specialty distribution
• Demonstrates a broad and wide understanding of the physician buy and bill model vs assignment of benefits to alternate sites of care
• Understands and is able to establish alternate sites of care to support patient options.
• Possess expertise in Medicare policies and the variations within all parts of Medicare
• Ensure processes are in place to drive clear communication with sales teams to ensure clarity of reimbursement and access issues and opportunities and support pull-through efforts.
• Listen and respond appropriately to customer needs and questions.
• Effectively and persuasively communicate with customers using effective selling, listening and negotiation skills, proper terminology and approved messaging.
• Maintain thorough knowledge of Sun products.
• Regularly and timely communicate with manager, as well as members of various support teams, as required.
• Create and maintain a positive impression with customers.
• Prepare reports for management as needed.
• Participate in teleconference and live National, regional and district meetings and training sessions and represent Sun at national and/or local conventions when requested.
• Ensure behaviors consistent with Healthcare Compliance guidelines.

Job Qualifications

A minimum of a Bachelor’s Degree is required.

5 or more years of healthcare industry experience required. A minimum of 3 years’ experience in the healthcare industry including a strong understanding of but not limited to, insurance verification and / or claim adjudication, physician office and outpatient billing, medical benefit procurement, understanding of adjudication within Commercial and Government payers, buy and bill model, Medicare, Tricare , Medicaid and National and Regional Commercial payers. Experience working in Dermatology and/or Oncology is a plus.

Additional Requirements

• Proven teamwork and collaboration skills with a demonstrated track record of working in highly matrixed and cross-functional work teams
• Applies appropriate interpersonal styles and communications methods to influence and build effective relationships with business partners.
• Able to effectively manage competing priorities with strong sense of urgency.
• Able to act as an articulate advocate for the market access team
• Provides consistent communications (both positive and negative information delivery) and is proactive and time in the conveyance of this information.
• Uses appropriate methods and interpersonal styles to develop, motivate, and guide a team toward successful outcomes and attainment of business objectives.
• Strong written and verbal communication skills.
• Strong presentation skills.
• Highly developed analytical skills with demonstrated ability to conceptualize issues and synthesize data to provide strategic direction
• Experience in Sun Pharma’s therapeutic areas: Dermatology, Oncology, Biologics preferred
• Acts as a role model for others in line with Sun’s values

The presently-anticipated base compensation pay range for this position is $145,000 to $175,000. Actual base compensation may vary based on a number of factors, including but not limited to geographical location and experience. Employees are eligible to participate in Company employee benefit programs which include medical, dental and vision coverage; life insurance; disability insurance; 401(k) savings plan; flexible spending accounts; and the employee assistance program. Employees also receive various paid time off benefits, including vacation time and sick time.

The compensation and benefits described above are subject to the terms and conditions of any governing plans, policies, practices, agreements, or other materials or documents as in effect from time to time, including but not limited to terms and conditions regarding eligibility. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company, or individual department/team performance, and market factors.

Disclaimer

The preceding job description has been designed to indicate the general nature and level of work performed by employee within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees as assigned to this job. Nothing herein shall preclude the employer from changing these duties from time to time and assigning comparable duties or other duties commensurate with the experience and background of incumbent(s).

We provide equal employment opportunities for all current employees and applicants for employment. This policy means that no one will be discriminated against because of race, religion, creed, color, national origin, nationality, citizenship, ancestry, sex, age, marital status, physical or mental disability, affectional or sexual orientation, military or veteran status, generic predisposing characteristics or any other basis prohibited by law.

Notice to Agency and Search Firm Representatives: Sun Pharmaceuticals Industries, Inc. (Sun) is not accepting unsolicited resumes from agencies and/or search firms for this job posting. Resumes submitted to any Sun employee by a third party agency and/or search firm without a valid written & signed search agreement, will become the sole property of Sun. No fee will be paid if a candidate is hired for this position as a result of an unsolicited agency or search firm referral.