Retina Access & Reimbursement Manager, Field-Based

Outlook Therapeutics, Inc.; Houston (TX); Vor Ort; USD 95.000 - 170.000; Vollzeit

Benefits dieser Stelle

Competitive base salary

Annual performance bonus

Equity

Health coverage

401(k) with company match

Generous paid time off

Direct access to leadership

Growth opportunities

Zusammenfassung

Outlook Therapeutics, Inc. is seeking a field reimbursement and access expert to drive payer strategy and support our U.S. retinal product launch.

You will educate practices on coverage, manage prior authorizations, and coordinate with field teams to ensure seamless access for patients in your territory. The role requires 5–10 years in reimbursement/market access, strong payer knowledge, and solid data-driven decision making. Travel 50–75% within the U.S.

Qualifikationen

• 5–10 years of combined experience in reimbursement, market access, patient services, or a related field within pharmaceuticals, biotech, or specialty healthcare.
• Hands-on experience navigating Medicare (including MACs), Medicare Advantage, Medicaid, and commercial payer coverage.
• Practical experience with benefit verification, prior authorization, claims support, and the appeals process.
• Track record of using claims data to identify denial trends and coding-related barriers.
• Strong verbal and written communication skills, with the ability to build trust with office staff without engaging in promotional discussion.
• Proficiency with CRM systems and Microsoft Excel.
• Ability to travel within an assigned territory (typically 50–75%, including some overnight travel); valid driver’s license required.

Aufgaben

• Serve as the primary field reimbursement resource for practice administrators, billing/coding staff, and clinical teams supporting our retina portfolio.
• Educate office staff on payer coverage policy, medical-benefit billing and coding (HCPCS/CPT/J-codes, ICD-10, modifiers), prior-authorization requirements, and clean-claim submission.
• Guide practices through the prior-authorization and appeals process, clarifying payer-specific requirements and documentation.
• Connect practices to patient-support resources when a case needs that level of help.
• Own a defined territory of retina/ophthalmology accounts and build trust that makes you the first call for a reimbursement problem.
• Lead quarterly business reviews, analyzing reimbursement performance and denial trends and leaving each account with a concrete plan to fix what isn’t working.
• Monitor accounts for early warning signs — rising denials, patients not being filled due to access friction — and get ahead of the problem with a targeted plan.
• Coordinate with Sales so every account gets one consistent, compliant message.
• Analyze account-level claims data to spot denial patterns, coding errors, and payer-specific quirks, and turn findings into plain-language guidance practices can act on.
• Track how commercial, Medicare, Medicare Advantage, and Medicaid plans are covering the territory’s products as policy shifts.
• Escalate systemic payer issues — a policy change, a recurring denial pattern — to Access & Reimbursement leadership with supporting data and a recommended next step.
• Support U.S. launch readiness by mapping the payer landscape and feeding access-strategy input to Market Access ahead of approval.
• Partner with the patient support hub and Patient Services so benefit verification, prior-authorization/appeals help, and patient-assistance referrals move smoothly between teams.
• Bring a field-level view into cross-functional territory and launch planning.
• Keep account activity, QBR outcomes, and issue resolution logged accurately and on time in the CRM.

Kenntnisse

Reimbursement

Market access

Patient services

Payer policies

CRM systems

Microsoft Excel

Travel readiness

Tools

CRM systems

Microsoft Excel

Jobbeschreibung

Outlook Therapeutics, Inc. is seeking a field reimbursement and access expert to drive payer strategy and support our U.S. retinal product launch.

You will educate practices on coverage, manage prior authorizations, and coordinate with field teams to ensure seamless access for patients in your territory. The role requires 5–10 years in reimbursement/market access, strong payer knowledge, and solid data-driven decision making. Travel 50–75% within the U.S.