Field Reimbursement Manager - Tennessee

Ocular Therapeutix, Inc.; Nashville (TN); Hybrid; USD 200,000 - 220,000; Full time

Job summary

Ocular Therapeutix, Inc. is seeking a Field Reimbursement Manager to educate purchasers and providers on reimbursement pathways for DEXTENZA®. The role covers TN, AL, MS with significant travel and cross-functional collaboration across payer, HUB, and field teams.

Applicants should have 5–7 years of reimbursement experience in pharma/biotech, strong knowledge of medical benefits, and the ability to navigate complex payer policies while supporting access programs for patients.

Qualifications

• BA/BS degree required.
• Minimum 5-7 years of prior reimbursement and access experience preferred.
• Minimum 3 years of other related pharma/biotech experience strongly preferred.

Responsibilities

• Educate purchasers, prescribers and staff on reimbursement and coding for DEXTENZA®.
• Resolve access and reimbursement issues and provide education for appropriate reimbursement.
• Coordinate with Field Sales to prioritize accounts and share payer policy insights.
• Serve as HUB liaison and educate customers on patient assistance programs.

Skills

Reimbursement experience

Cross-functional collaboration

Travel readiness

Education

BA/BS degree

Job description

Ocular Therapeutix, Inc. (NASDAQ:OCUL) is a biopharmaceutical company focused on the formulation, development, and commercialization of innovative therapies for diseases and conditions of the eye using its proprietary bioresorbable hydrogel-based formulation technology, ELUTYX™. Ocular Therapeutix has built a robust product pipeline of drug delivery solutions developed to reduce the complexity and burden of the current standard of care and position itself to become a leader in the ophthalmic space. Outside of the ophthalmic realm and behind the doors of our headquarters in Bedford, MA, we strive to build a strong culture where employees can flourish and achieve their career goals. We encourage out of the box thinking, cross-functional collaboration, and creativity.

THIS POSITION COVERS TN, AL, MS

Position Summary

The Field Reimbursement Manager (FRM) is a regionally aligned, field-based position that provides access and reimbursement education and support for customers that utilize DEXTENZA® from Ocular Therapeutix. Customers will include Healthcare Providers (HCPs) and staff within offices, ambulatory surgery centers (ASCs), hospital outpatient departments (HOPDs), and other appropriate site-of-care facilities. The FRM will work closely with internal/external stakeholders including HCPs, billing and coding staff, revenue cycle managers and other professionals involved in securing appropriate Access & Reimbursement for the use of DEXTENZA®.

The FRM provides support through (1) product-specific reimbursement support, (2) coordination of HUB reimbursement services, and (3) managing payer/coverage pull-through initiatives. The FRM must have a solid working knowledge of buy-and-bill products with Medical (Part-B) reimbursement, as well as a clear understanding of all Public and Private insurance plans and benefit design.

The FRM is expected to be a subject matter expert on access & reimbursement processes for a product with a permanent J Code and paid under the Medical benefit (i.e., benefit verification, claim assistance, and appeals). In addition, the FRM needs to build and maintain strong relationships with provider practices and facilities, while implementing and managing field reimbursement responsibilities. The FRM role includes a high degree of communication, account coordination and cross-functional collaboration.

Principal Duties And Responsibilities Include The Following

• Proactively educate the purchaser (Clinic, ASC, or HOPD), prescriber and office personnel so they may help patients gain access to our products. Educate on coding of DEXTENZA® and how to pull-through using J-codes, including payer specific instructions on reimbursement/billing with both government and private payers, using PRC approved materials.
• Reactively address access and reimbursement issues and provide necessary education for them to secure appropriate reimbursement and access.
• Provide PRC approved information related to product coverage, which may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state.
• Interact with healthcare professionals, to understand access and reimbursement issues and work toward resolution. Maintain communication with all cross-functional partners throughout interactions and follow through to resolution.
• Interact regularly with National Account Directors and Key Account Managers, to provide field intelligence and disseminate payer policy and market dynamics.
• Coordinate with field sales regarding prioritization of accounts to ensure targeted, timely lists of key accounts. Ensure ongoing communication with field sales regarding account follow-up plans.
• Serve as a primary point of contact for Market Access team for corporate accounts, distribution, HUB, and payer issues.
• Act as the HUB liaison to educate customers on appropriate available patient support programs. Explain financial assistance and other funding options available to patients for Ocular products. Help the practice understand how to enroll patients in appropriate programs. Advocate for DEXTENZA® HUB utilization for patient-specific access support needs.

Internal And External Contacts

• The FRM must work effectively with multiple internal & external stakeholders in a matrix environment to achieve target objectives and meet established MBO’s/goals.
• Internal: Field Sales, Corporate Accounts, Payer Team, Marketing, Trade and Distribution, HUB manager, outsourced HUB services, and Medical Director (as needed).
• External: HCP’s, Clinics, HOPDs, ASCs, pharmacy, and billing/coding staff associated with key customers

Qualification Requirements

• BA/BS degree required
• Minimum 5-7 years of prior reimbursement and access experience preferred
• Minimum 3 years of other related pharma/biotech experience strongly preferred (e.g., Market Access, Sales, Product Marketing)
• Prior experience launching specialty therapeutics in “buy and bill” environment
• Comprehensive understanding of medical benefit policies across payer types (Medicare, Medicaid, commercial, VA/DoD, etc.) and sites of care (HOPD, ASCs, Clinics)
• Ability to lead without authority within cross-functional groups and in a matrix organization
• Exceptional professional communications and interpersonal/problem-solving skills necessary to interact with key decision makers (CFO, revenue cycle, and other c-suite level stakeholders)
• Demonstrated ability to identify key access barriers and design effective resolution plans
• Ensures compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance Qualifications
• Desire to innovate and work in a fast-paced, energetic environment
• Candidates must live near a major airport and be willing and able to travel approximately 70-75% of the time (average 4 days per week)

Salary Range: $200,000 USD - $220,000 USD

Ocular Therapeutix is an Equal Opportunity Employer and complies with all applicable federal, state, and local laws regarding nondiscrimination. Ocular Therapeutix provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, or status as a veteran. For information on how Ocular Therapeutix collects, stores, and utilizes candidate information please see our privacy policy found at https://www.ocutx.com/privacy-policy/. For the Privacy Notice for California Job Applicants, please see CCAA Applicant Notice.