Field Reimbursement Manager, Immunology Gastroenterology

Role Summary

Field-based Immunology Field Reimbursement Manager – Gastroenterology, serving Alabama, Northern Mississippi, and Memphis, Tennessee. The role acts as an in-office resource addressing HCP questions about patient access and reimbursement for the assigned portfolio. The FRM provides expertise on coverage and reimbursement challenges, educates providers on access tools, program eligibility, and payer processes and procedures. This role requires living within a reasonable distance from the primary city and travel within the geography as needed.

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 the access and reimbursement support center to update HCPs on Rx status and program eligibility
• Report back payer trends related for approved products to Patient Services and MHC account management teams
• Establish and maintain relationships with appropriate providers within territory
• Remain current on key managed care, reimbursement, and policy activities

Qualifications

• Required: At least 3 years of pharma industry experience in Managed Health Care, Payer Account Management, and/or Access and Reimbursement
• Preferred: Previous experience working within Immunology
• Required: Bachelor's degree
• Required: Thorough understanding of the technical payer policy processes, systems and requirements for coverage, coding and payment for specialty medicines
• Required: Demonstrated understanding of the rules, regulations and risks associated with provision of reimbursement support services
• Required: Strong understanding and ability to communicate technical elements of coding and billing requirements at the National and Regional level across all settings of care
• Required: Comprehensive understanding of Parts A, B, C and D or Medicare and associated reimbursement dynamics
• Required: Strong understanding of drug acquisition and dispensing (Specialty Pharmacies, Specialty Distributors and white-bagging, etc.)
• Required: Strong understanding of access and reimbursement support service centers and how to effectively interact in a compliant fashion
• Required: Excellent territory and account management skills
• Required: Driving a personal auto or company car or truck, or a powered piece of material handling equipment
• Required: Valid driver’s license: Ability to pass a pre-employment drug screening test and meet safe driving requirements
• Required: An essential requirement of your position is to satisfy all applicable health care industry representative (HCIR) credentialing requirements to gain and maintain entry into facilities and organizations in your assigned territory. You must also be in good standing and/or eligible to obtain these credentials
• Required: These HCIR credentialing requirements may include, but are not limited to, background checks, drug screens, proof of immunization/vaccination for various diseases, fingerprinting and specific licenses required by individual state or cities. You are responsible for satisfying all HCIR credentialing requirements