Field Reimbursement Manager

Location: Remote, Central US
Reports To: Head, Market Access

About This Role:

The Field Reimbursement Manager plays a critical role in facilitating patient access to new therapies by leveraging their expertise in coverage, payer policies, and patient assistance programs. Through education and partnership with office staff, they help navigate the access journey and identify solutions.  

This role is customer facing and will provide personalized issue resolution by partnering closely with the dedicated patient support (hub) and specialty pharmacy team. They will also collaborate closely with local/regional sales teams supporting targeted accounts, ensuring patients and providers experience minimal barriers to access. 

This role will support accounts located in Texas, Missouri, Illinois, Michigan, Wisconsin, and Minnesota.

What You'll Do: 

• Demonstrate deep understanding of reimbursement and access and act as the subject matter expert in their assigned territory.
• Demonstrate extensive knowledge of individual managed care account’s geographic presence/influence, payer mix, product coverage and reimbursement criteria policies.
• Educate providers on prior authorization requirements, coverage status, payer appeals requirements, alternate funding options for the uninsured and under insured, and all associated processes and timelines.
• Provide access education to HCPs and office staff as needed
• Serve as a liaison between sales reps and key external customers.
• Create and maintain productive relationships with HCPs, key stakeholders within HCP offices, and health care systems.
• Utilize knowledge to assist customers in navigating the complexity of specialty pharmacy distribution.
• Partner daily with the specialty pharmacy case management team to ensure accurate coverage determinations, and optimized processing of enrollments for timely access of product for patients.
• Partner with the sales team and patient hub/SP to identify both accounts that are experiencing reimbursement issues and specific patients that are not moving forward due to insurance delays.  
• Develop and implement innovative solutions for patient access with system and individual situations.
• Perform strategic analyses to develop business plans that identify issues and opportunities.
• Role involves significant travel (up to approximately 70% of time). The Field Reimbursement Manager will meet customers, attend appropriate conferences, and is expected to travel in the field with sales and regional colleagues to call upon key providers and influencers.

Required Skills:

• B.S./B.A. degree or higher and 8+ years of experience in the pharmaceutical or biotechnology industry, with expertise in biotech drug distribution across specialty distributors, specialty pharmacies, and hospital systems.
• Demonstrated  understanding of coverage and reimbursement for oral and injectable therapies.
• Strong expertise in Specialty Pharmacy operations and third-party services (Patient Support).
• Deep knowledge of payer/PBM utilization management tactics for new therapies such as new to market blocks and exclusion lists required.
• Extensive understanding of pharmaceutical manufacturer compliance, patient confidentiality, product reimbursement and product access requirements
• Knowledge of regulations and laws governing the protection