Field Reimbursement Manager - Northwest

Job Title

Field Reimbursement Manager - Northwest

Requisition

JR000015768 Field Reimbursement Manager - Northwest (Open)

Location

Seattle, WA

Additional Locations

Portland, OR

Job Description Summary

The Field Reimbursement Manager (FRM) position is a critical front-line member of the Access and Reimbursement Team. The main driver of Patient Access is patients and assisting provider offices to help their patients get access to care to get them back to living their best lives. The FRM role is a field-based position whose job is to minimize access and reimbursement barriers for patients and providers.

Within their geography, the FRM provides access and reimbursement education to physician office personnel, billing staff/companies, HCPs, as well as anyone involved in the process of utilizing the product with the intention of minimize barriers and increasing access to care. FRM education hones in on therapies, how to buy and bill our products, acquire through specialty pharmacies and educate on office processes. FRMs also support provider offices on a reactive basis by providing education and guidance in response to PA denials and claim denials and/or underpayments. The FRM will leverage all data analytic tools to minimize delay in receiving treatment by working with internal and external customers.

Job Description

Provider Account Support

• Subject matter expert for all reimbursement/access and acquisition logistical aspects of a high touch biologic medication for an orphan disease and testosterone products with multiple acquisition options within a changing payer landscape. This includes: payer policies, prior authorization requirements, denial and appeal process, peer to peer, and other education required to navigate access for the appropriate patients.
• Assists HCP offices with questions related to Buy/Bill BI management. Educate/Assist with Specialty Pharmacy (SP) understanding, expectations and logistics. Continually educate office staff on appropriate steps, educate on the importance of chart documentation, keep offices up to date on payer policies for products and triage issues to the appropriate HUB and SP.
• Primary responsibilities include:
• Managing patient assistance and reimbursement support services offered to providers and related to patient access to buy/bill products.
• Coordinating with patient support services program representatives.
• Educating office staff on the use of Buy/Bill products, patient assistance and reimbursement support services.
• Participating in sales training related to product reimbursement.
• Utilizing data to critically think through acquisition challenges from a variety of outlets including SP, Specialty Distributors and Title sales.
• Assist new offices from a reimbursement perspective to inform them about reimbursement issues as well as providing education on various MARC approved resources pertaining to reimbursement, acquisition and coding.
• Act in a compliant manner at all times.

Specialty Pharmacy (SP) Support

• FRMs work closely with the external and internal customers to trouble shoot any SP related issues. FRMs work closely with their NAE partner to manage any customer related issues directly with the SP's.
• SP experience is critical. Each FRM should be an expert SP logistics and operations.
• FRMs must be able to analyze data and know how to make that data into actionable steps to facilitate patient access to products.
• Work closely with SP's to understand logistical issues that arise and provide MARC approved resources and programs to facilitate patient access as well as communicate with SP's to find resolutions to issues that arise at the SP.
• Identify gaps in knowledge of accounts from a SP process and help provide education for the account and physician.
• Develop short- and long-term account plans for key accounts with the goal of smoothing out the process of acquiring drug to optimize acquisition and patient journey.

Internal Partnerships

• Consistent, reliable, timely and high-quality support of the field, as well as all other internal commercial functions.
• Strong leadership role to the field teams by establishing a solutions oriented approach, working with your Sales Representatives/ASMs to build and execute local plans to overcome barriers to Buy/Bill products access. Specific examples include:
• Identify in conjunction with the field, specific targeted accounts where the FRM will assist with product acquisition or SP dispense.
• Partner with the ASMs to build local business plans; participate in district business reviews as the expert resource on the reimbursement landscape from regional, district, state and local perspective.
• Provide the teams with actionable feedback (across the organization) on support programs such as the Helpline, copay card, SPP performance, so as to guide changes to improve access.
• Help educate the internal customers on managed market dynamics specific to SP's/SD's as well as local payor issues-needs. Track customer trends in order to help inform internal business decisions, e.g. Health care policy changes.
• Proactively use business analytics to understand common logistical issues in top accounts and proactively develop plans for education and to find solutions for better patient access to all supported specialty products. Ensure alignment with ASM and District Strategy.
• Provide support to sales representatives, ASMs and Internal Stakeholders on rules of engagement to educate and further clarify what is appropriate.

Advocacy

• Works with the field to identify potential payer advocates and supports the National Account Management team on issues relating to medical policy development and execution at the HCP level.
• Ensure all approved promotional speakers have an in-depth understanding of billing/coding, logistics and payer coverage.

• Other duties as assigned.

Education & Experience

• BS or equivalent is required; MBA or advanced degree preferred.
• 5-7 years of relevant experience in the Biopharma industry required.
• Three years' experience in 3rd party reimbursement and managed care experience
• Significant experience in patient access support, i.e., copay programs, HUB management, payer experience, etc.
• Superb knowledge and operationalizing experience of buy & bill and SP pathways.
• Previous experience working with vendor relationships desirable.
• Previous experience managing customer interactions required.
• Previous sales management and/or account management experience highly desirable.
• All newly hired FRMs should enter at this level regardless of their tenure or experience elsewhere.

Knowledge

• Systemic understanding of the global payer and distribution environment, in particular, physician administered biologics in the U.S.
• Understanding of coverage, coding (diagnostic, procedural and product), payment and reimbursement requirements and policies.
• Knowledge/expertise in commercial payer policy.
• Knowledge/expertise in Local Coverage Determinations (LCDs) per each regional MAC for all products.
• Knowledgeable on Medicare billing/coding and appeal process. ASP, WAC as well as Sequestration; interpret and understand Medicare EOBs and CMS 1500 forms.
• Understands the legislative, legal and regulatory environments and anticipates potential impact to the Company.
• Solid understanding of coverage policy creation, interpretation, and management.

Skills & Abilities