Field Reimbursement Manager, Immunology Gastroenterology

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Role Summary

Field Reimbursement Manager, Immunology Gastroenterology is responsible for educating healthcare professionals on patient support programs, access and reimbursement tools, and for providing local expertise on payer policies. This role liaises with payer groups, coordinates with reimbursement centers, and maintains provider relationships within the territory to ensure appropriate claims submission and ongoing access to therapies.

Responsibilities

• Educate HCPs on patient support programs, including access and reimbursement support tools and services
• Educate on product-specific acquisition and access options such as specialty pharmacy networks and specialty distribution
• Educate on resources available to address access issues
• Provide local expertise regarding national/regional payor policies to educate providers on payer issues, coding changes, and appropriate claims submission processes
• Liaise with Access and Reimbursement support centers to update HCPs on Rx status and program eligibility
• Report payer trends related to approved products to Patient Services and account management teams
• Establish and maintain relationships with appropriate providers within the territory
• Remain current on key managed care, reimbursement, and policy activities

Qualifications

• At least 3 years of experience in Immunology with experience in Managed Health Care, Payer Account Management, and/or Access and Reimbursement
• Thorough understanding of the technical payer policy processes, systems and requirements for coverage, coding and payment for specialty medicines
• Demonstrated understanding of the rules, regulations and risks associated with provision of reimbursement support services
• Strong understanding and ability to communicate technical elements of coding and billing requirements at the National and Regional level across all settings of care
• Comprehensive understanding of Parts A, B, C and D or Medicare and associated reimbursement dynamics
• Strong understanding of drug acquisition and dispensing in the Neuroscience space (Specialty Pharmacies, Specialty Distributors and white-bagging, etc.). Strong understanding of access and reimbursement support service centers and how to effectively interact in a compliant fashion
• Excellent territory and account management skills
• Bachelor’s degree / Valid driver’s license
• HCIR credentialing requirements: ability to satisfy all applicable health care industry representative requirements to gain and maintain entry into facilities and organizations within the assigned territory
• Compliance with credentialing requirements may include background checks, drug screens, immunization proof, fingerprinting, and state/city licenses; individual responsibility to satisfy all HCIR requirements

Education

• Bachelor’s degree