Associate Director, Field Reimbursement
Pacira BioSciences, Inc.
4 months ago
Remote
United States
Market Access
Summary
- Associate Director, Field Reimbursement (customer-facing) managing defined accounts within a specified region in the Non-Opioid Pain Therapeutic area. Supports specialty buy-and-bill therapy by driving product reimbursement and coverage, removing access barriers, and partnering with internal/external stakeholders. Serves as internal expert on medical coding, billing, and reimbursement.
Responsibilities (Essential Duties)
- Act as an extension of EXPAREL & ZILRETTA, providing live one-on-one coverage support.
- Support the reimbursement journey from physician order through payer prior authorization to appeals/denials requirements, procedures, and forms.
- Review patient-specific information for site-requested assistance resolving coverage issues.
- Review patient insurance benefit options.
- Coordinate with Pacira patient support services program representatives.
- Educate physician office staff on use of Pacira call center support services, including web-based provider programs.
- Provide reimbursement topic information related to Pacira’s portfolio.
- Serve as payer expert for defined geography; communicate changes to key stakeholders in a timely manner.
- Provide office support in accurate coding and billing for Pacira’s portfolio.
Qualifications
- Bachelor’s degree in Health Policy, Finance, Business, or related field.
- 6+ years related healthcare industry experience.
- 3+ years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.
Knowledge/Skills/Abilities (required)
- Payer policy knowledge (managed care, Medicare/Medicaid) and prior authorization/benefit verification.
- Knowledge of reimbursement and physician-office billing processes.
- Ability to review clinical information and interpret payer policy to guide HCP offices on prior authorization/formulary exception/appeals documentation.
- Specialty buy-and-bill product knowledge, coding, and in-office program management best practices.
- Track record managing medical billing/coding (appeals, denials, single case rates).
- Excellent written/verbal communication, including executive-level presentations.
- Ability to partner and accomplish goals across the organization without direct reporting.
- Strategic thinking, problem-solving, analytic and negotiation skills.
- Understanding of CMS and commercial payment models/trends.
- Valid driver’s license.
Benefits (as listed)
- Medical, Prescription, Dental, Vision; Flexible Spending Account & Health Savings Account (company match); Employee Assistance Program; Mental Health Resources; Disability Coverage; Life insurance; Critical Illness and Accident Insurance; Legal and Identity Theft Protection; Pet Insurance; Fertility and Maternity Assistance; 401(k) with company match; Flexible Time Off (FTO) and 11 paid holidays; Paid Parental Leave.
- Associate Director, Field Reimbursement (customer-facing) managing defined accounts within a specified region in the Non-Opioid Pain Therapeutic area. Supports specialty buy-and-bill therapy by driving product reimbursement and coverage, removing access barriers, and partnering with internal/external stakeholders. Serves as internal expert on medical coding, billing, and reimbursement.
Responsibilities (Essential Duties)
- Act as an extension of EXPAREL & ZILRETTA, providing live one-on-one coverage support.
- Support the reimbursement journey from physician order through payer prior authorization to appeals/denials requirements, procedures, and forms.
- Review patient-specific information for site-requested assistance resolving coverage issues.
- Review patient insurance benefit options.
- Coordinate with Pacira patient support services program representatives.
- Educate physician office staff on use of Pacira call center support services, including web-based provider programs.
- Provide reimbursement topic information related to Pacira’s portfolio.
- Serve as payer expert for defined geography; communicate changes to key stakeholders in a timely manner.
- Provide office support in accurate coding and billing for Pacira’s portfolio.
Qualifications
- Bachelor’s degree in Health Policy, Finance, Business, or related field.
- 6+ years related healthcare industry experience.
- 3+ years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.
Knowledge/Skills/Abilities (required)
- Payer policy knowledge (managed care, Medicare/Medicaid) and prior authorization/benefit verification.
- Knowledge of reimbursement and physician-office billing processes.
- Ability to review clinical information and interpret payer policy to guide HCP offices on prior authorization/formulary exception/appeals documentation.
- Specialty buy-and-bill product knowledge, coding, and in-office program management best practices.
- Track record managing medical billing/coding (appeals, denials, single case rates).
- Excellent written/verbal communication, including executive-level presentations.
- Ability to partner and accomplish goals across the organization without direct reporting.
- Strategic thinking, problem-solving, analytic and negotiation skills.
- Understanding of CMS and commercial payment models/trends.
- Valid driver’s license.
Benefits (as listed)
- Medical, Prescription, Dental, Vision; Flexible Spending Account & Health Savings Account (company match); Employee Assistance Program; Mental Health Resources; Disability Coverage; Life insurance; Critical Illness and Accident Insurance; Legal and Identity Theft Protection; Pet Insurance; Fertility and Maternity Assistance; 401(k) with company match; Flexible Time Off (FTO) and 11 paid holidays; Paid Parental Leave.