Field Reimbursement Manager

Role Summary

The Field Reimbursement Manager (FRM) is responsible for supporting patient access processes for the gastroenterology portfolio. The FRM leverages account management, data analytics, and reimbursement expertise to support timely access to products, execute the territory strategic plan, understand the patient access process, and navigate patient support programs. The FRMs will collaborate with key team members such as Field Sales and other internal stakeholders to serve as access and reimbursement experts for assigned geographies.

• Establish and maintain collaborative working relationships with Patient Services Program Partners, Field Sales, and Healthcare Providers to support patient access
• Aid HCPs with supporting the patient journey by providing education on prior authorization, appeals, and/or denials
• Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges when appropriate
• Partner with internal and external stakeholders to identify, anticipate and address patient and HCP access barriers;
  Implement updates/changes based on solutions generated to address barriers
• Utilize HUB and specialty pharmacy partners to ensure patient access barriers are removed
• Monitor patients start trends in assigned geographies/plans, and collaborate with Field Sales and Patient Services partners to proactively address and mitigate challenges
• Maintain knowledge of national, regional, local, and account market dynamics for payors and prescribers; maintain knowledge of HUB and specialty distribution channels to support patient needs
• Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial)
• Understands and adapts to the changing healthcare ecosystem to customize resourcing and messaging to HCPs and HCP staff

• B.A/B.S. degree with 6 - 9 years of experience in field reimbursement, patient services, market access, or related functions within the pharmaceutical/biotech industry or equivalent experience
• 3 - 5 years of experience as a field reimbursement manager within public or private field reimbursement or access services, healthcare operations, and/or equivalent experience
• Extensive knowledge of medication access channels preferred
• Strong functional knowledge of specialty pharmacy and health insurance and benefits (i.e. Medicare Part D, commercial and Medicaid) with a demonstrated expert understanding of insurance eligibility, benefit verification, prior authorization processes, reimbursement coverage, appealing insurance denials, application of financial assistance, co-pay support and free product programs
• Knowledge of HCP office processes regarding patient flow, prescription flow and clinic office operations. Direct experience with GI products or providers preferred
• Outstanding customer relationship, interpersonal, and communication skills with the established ability to effectively work with diverse audiences and influence cross-functionally
• Ability to evaluate data and identify trends, barriers, and translate into actionable steps

• Analytical thinking and data-driven decision making
• Stakeholder management and cross-functional collaboration
• Excellent communication and interpersonal skills
• Adaptability to the evolving healthcare ecosystem and changing payer landscape
• Education and patient education: ability to educate HCPs and staff on access and reimbursement processes

• B.A./B.S. degree in a related field

• Travel up to 75% in the field; travel will vary by territory and business need