Job Description
Job Description Target PR Range: 43-53/hr
Job Description: The Field Reimbursement Manager will be responsible for managing the day-to-day tactical field-based reimbursement activities in their geography including but not limited to conducting field reimbursement in-services and educational workshops for Patient Advocacy groups, Health Care Professional (HCP) offices, Specialty Pharmacies and distributors for all therapies. Works with payer and channel Customer Account Managers in educating and resolving reimbursement issues with all accounts. Works with field sales organization and third party patient access programs to resolve reimbursement issues and improve patient access to therapies. Works directly with consumer groups for reimbursement education and training, and manages relationships with regional Medicare offices and Carrier Advisory Committees.
Main Responsibilities And Accountabilities: - Work with payers, specialty pharmacies, physician champions, and professional societies to secure adequate reimbursement of therapies
- Aid physicians, sites of service and their support staff in the reimbursement process. Provide in-service training to sales and marketing on the fundamentals of healthcare economics.
- Execute reimbursement strategies that proactively integrate and align with marketing and sales strategies.
- Execute strategies with third party payers to insure adequate reimbursement (hospitals, home health providers, ambulatory care centers and physicians)
- Work directly with third party payers and Medicare offices to insure adequate reimbursement for our products.
- Provide monthly report recounting significant activities, progress and follow-up needed.
- Assess reimbursement environment (coverage, coding and payment) for any new products and procedures.
- Work with payer and channel Customer Account Managers in educating and resolving reimbursement issues with SP (Specialty Pharmacy) accounts, and attend customer account calls with payer and channel CAMs as needed to present reimbursement information on therapies and answer any questions the accounts may have.
- Work with field sales organization and third party patient access programs via patient access hotline (HUB) to resolve reimbursement issues and improve patient access to therapies.
- Perform field reimbursement in-services such as account visits, presentations to healthcare providers and other medical staff. Conduct billing procedure review for home care companies, pharmacies, and other providers experiencing inadequate reimbursement across the portfolio.
- Work directly with consumer groups to supply reimbursement education and training. This should be accomplished by attending and conducting patient education workshops at regional and national consumer group meetings (IDF, JMF, HAEA, NHF, etc.).
- Work with consumer groups to coordinate the use of Assurance and Assistance programs. Return patient and family calls regarding insurance and appeals, and assist in a positive outcome.
- Collaborate with the Patient Services team to ensure the Hub offerings are up to date with the changing reimbursement landscape, including HUB training and managing challenging cases.
- Attend trade shows when requested (AAAAI, HAEA, NHF, NHIA AMCP, CMSA, etc.), and be able to present reimbursement information as requested by the various groups.
- Candidate should be located conveniently to a major airport and willing to travel up to 50%
Minimum Required Qualifications: - Bachelors degree in business, health policy, health economics, life sciences or healthcare discipline
- 3 - 5+ years' pharmaceutical industry experience in reimbursement or case management
- Strong understanding of relevant market reimbursement policy
Preferred / Nice To Have Qualifications: - Specialty product reimbursement highly desired
- CO/NYC candidates might not be considered
The Planet Group of Companies is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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