Field Reimbursement Manager – East

TSP

Overview

This Field Reimbursement Manager will be responsible for the management of defined accounts in the Eastern Region of the U.S. in support of our client’s oncology products. The Field Reimbursement Manager will execute the collaborative territory strategic plan through partnership with internal and external stakeholders. Responsibilities include ensuring understanding of reimbursement services and program support as it relates to an oncology franchise. The Reimbursement Manager will also work on patient level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI). Note this is not a sales job.

Responsibilities

The Field Reimbursement Manager will manage daily activities that support appropriate patient reimbursement for our products in hospitals and work as a liaison to other patient assistance and reimbursement support services offered. Activities include, but are not limited to:
Provide live one-on-one support to address questions about coverage requirements
Offer assistance from prescriber decision through to access, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms
Reviewing patient-specific information in cases where the site has specifically requested the assistance and patient health information is available in resolving any issues or coverage challenges
Reviewing patient insurance benefit options, in cases where patient health information is available as a result of patient SRF
Coordinating with other patient support service program representatives and with the field sales force, if necessary
Educating physician office staff on the use of the patient assistance program and support services
Provide information on relevant reimbursement topics related to the products
Serve as payer expert and be able to communicate changes to key stakeholders in a timely manner

Job Requirements
Bachelor’s degree required
Minimum 3 years’ experience in public or private third party reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
Experience with oncology products acquired through Specialty Pharmacy networks
Experience with coding, billing and in office support programs
Specialty Pharmacy experience required (ability to teach an office the entire process from script to administration of products)
Establishing relationships within a practice by working closely with them to help remove reimbursement barriers to products for their patients
Ability to operate as a “team player” in collaborating with sales representatives, sales leadership, and internal colleagues to reach common goals
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part B (Medical Benefit design and coverage policy) a plus
Knowledge of Commercial, Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory / targeting make up
Advanced knowledge of medical insurance terminology
Ability to manage expenses within allocated budgets
Ability to travel and possess a valid driver’s license to drive to assigned healthcare accounts, unless otherwise specified

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