- Preferred location (Southern California)
- Covered Territory(CA, AZ, NV, CO, IL)
Company Summary
Theratechnologies is a global specialty biopharmaceutical company headquartered in Montreal, Canada with business units in the US, Canada, and Ireland. Theratechnologies is focused on addressing unmet medical needs by bringing to market specialty therapies for people of greatest need.
Job Summary
The Field Reimbursement Manager (FRM) plays a critical role in minimizing access and reimbursement barriers for patients and healthcare providers to ensure timely access to the product portfolio. By addressing complex patient access challenges, the FRM serves as a trusted resource for private practices, multi-specialty groups, and facilities, supporting them throughout the reimbursement cycle. This role collaborates closely with Market Access, Patient Services, and Field Sales teams to ensure seamless patient drug accessibility and delivers compliant, patient-focused solutions to optimize access.
Key Responsibilities
- Proactively address patient access barriers by working with customers and accounts to resolve complex reimbursement issues, including prior authorizations, appeals, and denials.
- Educate private practices, multi-specialty groups, facilities, and their staff on reimbursement support programs, coverage, coding, and payer policies.
- Partner with internal and external stakeholders to identify, anticipate, and address patient and practice reimbursement challenges.
- Collaborate cross-functionally with Market Access, Patient Services, and Field Sales to provide compliant support for patients’ access to therapy.
- Deliver clear and actionable information to practice managers, billing staff, nurses, and reimbursement teams to improve their understanding of payer policies and processes.
- Provide real-time communication on payer policy updates and system changes that impact patient access in assigned accounts.
- Conduct regular reviews with practices to understand their utilization of reimbursement support services and recommend program enhancements based on customer needs.
- Handle patient health information (PHI) in accordance with HIPAA guidelines and company compliance policies.
- Maintain a deep understanding of policies, industry trends, and the legal and compliance aspects of reimbursement, applying this knowledge to all responsibilities.
- Ensure a compliant relationship with state, local, and institutional societies while educating and supporting practices and accounts.
- Share insights into customer needs, potential access barriers, and payer trends with internal teams to drive actionable improvements.
Minimum Qualifications Required
- Proven experience in resolving complex patient access challenges, including prior authorizations, appeals, and denials.
- Strong knowledge of the US healthcare system, reimbursement policies, and patient assistance programs.
- Familiarity with the appropriate handling and use of PHI under HIPAA and other relevant legal frameworks.
- Experience in HIV, Endocrinology, or rare diseases is preferred, along with expertise in sales, sales management, marketing, training, market access, or account management.
- Demonstrated ability to collaborate cross-functionally and manage stakeholder relationships effectively.
- Ability to analyze customer insights and market dynamics to adapt strategies for patient access and support.
Personal Qualities For All Staff
- Exceptional problem-solving skills with a patient-centered approach.
- Goal-oriented and results-driven with strong prioritization and time management skills.
- Excellent communication and relationship-building capabilities.
- Flexible and adaptable, with the ability to thrive in a dynamic environment.
- Strategic thinker with the ability to anticipate and address emerging trends in patient access and reimbursement.
- Collaborative mindset, capable of working independently and in cross-functional teams.
Travel Requirements:
- Willingness to travel as needed for field activities, meetings, and conferences, including overnight travel (>75%).
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran
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Inferred from the description for this job
Medical insurance
Vision insurance
401(k)
Paid paternity leave
Paid maternity leave
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