Field Reimbursement Specialist – Access & Payer Expert

Valeris; Atlanta (GA); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, and vision plans with

Health Savings Account options

401(k) Retirement Savings Plan with 5%

Job summary

Valeris is seeking a Field Reimbursement Manager to support patient access across sites of care. You will educate offices on billing and coding for client therapies, lead onsite payer education, and collaborate with HUB teams and sales to improve access to treatment.

The role requires experience with prior authorizations, reimbursement processes, and knowledge of Medicare/Medicaid structures. Travel up to 10% is expected in a dynamic field role.

Qualifications

• Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices.
• Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre‑determination requirements and knowledge of reimbursement processes within various sites of care.
• Demonstrated ability to conduct virtual and field‑based reimbursement support and education.
• Experience with Prior Authorizations, reimbursement billing, coding, and appeals process.
• Knowledge of commercial payer, Medicare and Medicaid structure, systems, and reimbursement process.

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team.
• Partner with client's Sales Team, Payer Teams, Marketing, HCPs, and their Specialty Pharmacies to create and drive strategic reimbursement support approaches.
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
• Lead HCP offices in onsite education of program business rules, payer coverage including review of miscellaneous J‑codes, and other reimbursement related activities.
• The FRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
• Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.
• Coordinate with client's patient support services programs representatives on patient cases and claim issues.
• Educate office staff on the use of client's patient assistance and reimbursement support services, including but not limited to web‑based provider programs and tools, and provide information on relevant reimbursement topics related to client's products.
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client's products.
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, as appropriate.
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
• Work collaboratively with Managed Markets team to upscale potential payer issues.
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data.

Skills

Prior Authorization experience

Coding experience

Billing experience

Education

Associate's degree or higher in a related field or equivalent market experience

Job description

Valeris is seeking a Field Reimbursement Manager to support patient access across sites of care. You will educate offices on billing and coding for client therapies, lead onsite payer education, and collaborate with HUB teams and sales to improve access to treatment.

The role requires experience with prior authorizations, reimbursement processes, and knowledge of Medicare/Medicaid structures. Travel up to 10% is expected in a dynamic field role.