Field Reimbursement Manager - Botox Therapeutic
AbbVie
9 hours ago
On-site
Omaha, NE
Market Access
Responsibilities:
- Share expertise and educate on Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payer policy, patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, patient tracking/retreatment, and the denial/appeal process for approved BOTOX Therapeutics indications.
- Clarify barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes.
- Educate on BOTOX treatment fundamentals, appropriate reimbursement, and understanding the payer landscape.
- Identify access and reimbursement barriers using advanced problem-solving/analytical skills and provide actionable insights.
- Uncover root causes of access issues that impede/delay proper treatment.
- Monitor and provide updates on Region and National payers (e.g., medical policy changes, prior authorization requirements, product acquisition) and exchange critical information compliantly.
- Liaise between internal stakeholders (Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, Specialty Pharmacy).
- Provide customer feedback on approval requirements and access barriers.
- Educate accounts on need-based patient access tools (HUB services, patient savings programs, payer coverage details, acquisition pull-through initiatives).
- Provide analytical, customized need-based solutions in complex, matrix-influenced settings.
- Build respectful relationships with healthcare professionals, staff, and business decision makers (including C-suite) within territory.
- Lead without authority; communicate effectively with diverse groups; influence across functions to reach consensus.
- Proactively engage in Field Input Teams; share customer challenges and potential solutions; plan/prioritize/follow up and anticipate problems.
Qualifications:
- 5–7+ years of proven success in a health care related field.
- Bachelor’s degree required.
- Preferred: Sales, district management, hospital, managed markets, access & reimbursement, or practice experience.
- Favorable: Lean Six Sigma knowledge.
- Exposure: physician-administered injectables; CPT and/or J-code reimbursement; Specialty Pharmacy and Buy & Bill acquisition; benefit verifications; prior authorizations; claim assistance; appeals; payer policies; HUB services.
- Experience with Medicare, Medicare Advantage, Commercial, and Medicaid plans.
- Strong verbal/written communication and in-person/virtual presentation skills.
- Competencies: problem solving, gain access, resource mastery, tangible results, overcoming adversity, collaboration, managing complexities.
- Soft skills: empathy, critical thinking, curiosity, persistence, reliability, resourcefulness.
- Strong leadership history.
- Technology/analytics: Salesforce, virtual meetings, Excel, report interpretation.
- Valid driver’s license.
- Ability to travel adequately (some overnight travel may be required).
Benefits:
- Paid time off (vacation, holidays, sick), medical/dental/vision insurance, and 401(k) to eligible employees; eligible for long-term incentive programs.
Application instructions:
- None provided in the job description.
- Share expertise and educate on Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payer policy, patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, patient tracking/retreatment, and the denial/appeal process for approved BOTOX Therapeutics indications.
- Clarify barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes.
- Educate on BOTOX treatment fundamentals, appropriate reimbursement, and understanding the payer landscape.
- Identify access and reimbursement barriers using advanced problem-solving/analytical skills and provide actionable insights.
- Uncover root causes of access issues that impede/delay proper treatment.
- Monitor and provide updates on Region and National payers (e.g., medical policy changes, prior authorization requirements, product acquisition) and exchange critical information compliantly.
- Liaise between internal stakeholders (Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, Specialty Pharmacy).
- Provide customer feedback on approval requirements and access barriers.
- Educate accounts on need-based patient access tools (HUB services, patient savings programs, payer coverage details, acquisition pull-through initiatives).
- Provide analytical, customized need-based solutions in complex, matrix-influenced settings.
- Build respectful relationships with healthcare professionals, staff, and business decision makers (including C-suite) within territory.
- Lead without authority; communicate effectively with diverse groups; influence across functions to reach consensus.
- Proactively engage in Field Input Teams; share customer challenges and potential solutions; plan/prioritize/follow up and anticipate problems.
Qualifications:
- 5–7+ years of proven success in a health care related field.
- Bachelor’s degree required.
- Preferred: Sales, district management, hospital, managed markets, access & reimbursement, or practice experience.
- Favorable: Lean Six Sigma knowledge.
- Exposure: physician-administered injectables; CPT and/or J-code reimbursement; Specialty Pharmacy and Buy & Bill acquisition; benefit verifications; prior authorizations; claim assistance; appeals; payer policies; HUB services.
- Experience with Medicare, Medicare Advantage, Commercial, and Medicaid plans.
- Strong verbal/written communication and in-person/virtual presentation skills.
- Competencies: problem solving, gain access, resource mastery, tangible results, overcoming adversity, collaboration, managing complexities.
- Soft skills: empathy, critical thinking, curiosity, persistence, reliability, resourcefulness.
- Strong leadership history.
- Technology/analytics: Salesforce, virtual meetings, Excel, report interpretation.
- Valid driver’s license.
- Ability to travel adequately (some overnight travel may be required).
Benefits:
- Paid time off (vacation, holidays, sick), medical/dental/vision insurance, and 401(k) to eligible employees; eligible for long-term incentive programs.
Application instructions:
- None provided in the job description.