Northwest Retina Field Reimbursement Lead (Launch)

Thea Pharma US; Seattle, Denver (WA, CO); On-site; USD 200,000 - 230,000; Full time

Benefits offered by this job

Health benefits

401(k)

Paid time off

Job summary

Thea Pharma Inc. is seeking a Field Reimbursement Manager – Retina to drive access and coverage for our retina portfolio across high-volume practices.

You will lead pre-launch readiness, educate billing staff, and troubleshoot complex claims while partnering with internal teams to ensure a seamless launch. Ideal candidates have 6+ years in medical reimbursement, ophthalmology/retina experience, and deep knowledge of Part B/D, ASP, and payer policies.

Qualifications

• Bachelor's degree required; an advanced degree or coding certification is a plus.

Responsibilities

• Pre-Launch Account Readiness: Conduct intensive pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices.
• J-Code Tracing: Educate practices on proper claims submission using new J-Codes and transition once ASP is established.
• Tracking First-Claim Success: Monitor initial claims submissions to identify payer rejections and formatting errors.
• Strategic Account Support: Serve as the subject matter expert on reimbursement and access for complex retina practices, ASCs, and hospital outpatient departments.
• Provider Education: Educate clinic staff and billing personnel on payer policies, prior authorizations, and coding.
• Reimbursement Troubleshooting: Analyze and resolve complex reimbursement issues and denials.
• Buy-and-Bill & Specialty Pharmacy Expertise: Guide practices on buy-and-bill operations and patient assistance programs.
• Local Payer Policy Tracking: Track local commercial and Managed Medicaid policy determinations for the product.
• Hub Coordination: Train staff on using the Patient Support Hub for benefits verification and prior authorization support.
• Cross-Functional Collaboration: Partner with Field Sales, Key Account Managers, and Patient Support Services.
• Travel requirement: Approximately 50% travel.

Skills

Presentation skills

Problem solving

Team collaboration

Microsoft Office

CRM platforms

Education

Bachelor’s degree

Coding certification / advanced degree

Tools

Microsoft Office

CRM platforms

Job description

Thea Pharma Inc. is seeking a Field Reimbursement Manager – Retina to drive access and coverage for our retina portfolio across high-volume practices.

You will lead pre-launch readiness, educate billing staff, and troubleshoot complex claims while partnering with internal teams to ensure a seamless launch. Ideal candidates have 6+ years in medical reimbursement, ophthalmology/retina experience, and deep knowledge of Part B/D, ASP, and payer policies.