Field Reimbursement Manager (Southern California)

The Lockwood Group®; Los Angeles (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Stratis Group is seeking a Field Reimbursement Manager to manage a dedicated territory, educating healthcare providers and office staff on access services and reimbursement solutions. You will coordinate with HUB and other access partners, ensuring smooth patient access and payer communications.

The role requires 3+ years in managed care, reimbursement, or related areas, a 4-year degree, and travel within the territory; solid analytical and presentation skills are essential.

Qualifications

• 3+ years of experience in Managed Care, Field Reimbursement, Patient Services, or Sales (Specialty/Biologics) or healthcare provider office practice management.
• 4-year degree in related field or equivalent experience.
• Ability to travel 3-4 days a week within territory and reside within it.
• Solution oriented mindset with strong business acumen and analytics.
• Experience with specialty/biologic products and complex reimbursement processes.

Responsibilities

• Manage daily activities that support patient access to the client’s products in provider offices and coordinate with HUB, Call Center, and Specialty Pharmacy Services.
• Act as an extension of client HUB, including in-person visits as needed.
• Participate in client meetings and team calls; log activity in CRM.
• Serve as payer expert for defined geography and communicate payer changes to stakeholders.
• Provide office education on access processes, including formulary, prior authorization, appeals, and claims resolution.
• Educate offices using approved patient access materials and educator resources.

Skills

Managed Care

Field Reimbursement

Patient Services

Sales (Specialty or Biologics)

Healthcare provider office practice mg

Travel 3-4 days a week

Education

4-year degree in related field or equivalent experience

Job description

About Stratis Group: Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand's lifecycle, our core passions include: market access, patient services, field reimbursement, and data-driven analytics.

Summary: In this contracted role, the Field Reimbursement Manager (FRM) is a client-facing and client-customer facing role that will be responsible for managing a dedicated territory to support access for provider and patients. This role will be highly visible within the organization and responsible for providing education to healthcare providers and office staff on access services and reimbursement solutions specific to a product and therapeutic area.

The FRM will execute a region or territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and/or other matrix field partners. Responsibilities include ensuring understanding of the reimbursement process, field reimbursement services, and client's patient support program. The FRM will also work on patient-level reimbursement issue resolution, and thus will need access to and have had experience with patient health information (PHI). The FRM will abide in a compliant manner and will work closely within a defined set Rules of Engagement.

In this role, the FRM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The FRM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.

Additional responsibilities include:

• Manage daily activities that support appropriate patient access to our client's products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients (i.e. HUB, Call Center, Specialty Pharmacy Services).
• Act as an extension of client's HUB, as appropriate and provide in-person customer visits.
• Participate in client meetings as appropriate. Participate in regularly scheduled team meetings and calls. Input call activity into customer CRM, as appropriate.
• Serve as payer expert for defined geography and able to communicate payer changes to key stakeholders in a timely manner.
• Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
• Educate offices using approved educational materials provided by the client.
• Review specific patient case information, in a compliant manner, defined by the client.
• Educate physician office staff on the use of our client's patient support services, including web-based provider portals.

Desired Job Requirements:

• 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
• 4-year degree in related field or equivalent experience
• Ability to travel 3-4 days a week, with overnights and flights (as needed), must reside within the territory
• Solution oriented mindset, strong business acumen, & strong analytic capabilities
• Experience with specialty/biologic products and/or complex reimbursement process
• Demonstrated ability to educate offices on access processes and issue resolution
• Experience educating HCPs on client specific Patient Service programs (i.e. copay, nurse education, bridge, patient assistance, etc.)
• Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
• Advanced knowledge of medical insurance terminology
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part B – for buy & bill products and Part D for Pharmacy products)
• Ability to manage ambiguity & problem solve
• Prepare and submit appropriate expense reports in a timely fashion
• Valid Driver's License