Position Summary:
The Field Reimbursement Manager (FRM) is a field-based expert in market access and reimbursement, providing education and guidance to healthcare providers and stakeholders across the access journey (claims submissions, prior authorizations, coverage criteria, and payer-specific requirements across commercial, Medicare, and Medicaid).
Responsibilities:
- Address patient access barriers by resolving complex reimbursement issues (prior authorizations, appeals, denials).
- Educate private practices, multi-specialty groups, facilities, and staff on reimbursement support programs, coverage, coding, and payer policies.
- Minimize access barriers so appropriate patients can obtain Invivyd products via HCP education.
- Provide clear, actionable information to practice managers, billing staff, nurses, and reimbursement teams.
- Conduct regular practice reviews; assess utilization of reimbursement support services and recommend program enhancements.
- Report payer trends related to approved products to Patient Services and Market Access account teams.
- Educate on coverage pathways for medical and pharmacy benefit products; deepen Medicare reimbursement knowledge.
- Train healthcare professionals on drug reimbursement process, coding, and billing.
- Stay current on business trends, regulatory changes, and healthcare policy developments; coordinate relevant stakeholders.
- Present insights and trends to commercial and executive leadership.
- Ensure activities adhere to pharmaceutical regulations, industry standards, and ethical guidelines.
Requirements:
- Bachelorβs degree strongly preferred; significant relevant experience without a degree will be considered.
- 8+ years in pharmaceutical/biotech with Market Access, Payer Account Management, and/or Access & Reimbursement.
- Ability to develop strategic account plans and oversee contract performance.
- Proven record meeting/exceeding business KPIs.
- Working knowledge of formulary inclusion and familiarity with sub-committees.
- Analytical mindset; interpret sales data, market trends, and customer insights.
- CRM and sales analytics tool experience.
- Travel ~60% of the time to meet customers and attend industry events.